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wsma_reports_know_what_youre_signingWSMA Reports: Know what you're signingLatest_NewsShared_Content/News/Reports/2018/wsma_reports_know_what_youre_signing<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/WSMA-Reports%20article%20graphic-2018-NovDec.jpg" class="pull-right" /></div> <h5>November 21, 2018</h5> <h2>Know what you're signing</h2> <p> BY TIERNEY EDWARDS, JD </p> <p> <em>The following Legal Matters column was featured in the November/December 2018 issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may <a href="https://wsma.org/WSMA/News_Publications/Publications/WSMA/News_Publications/Publications/Publications.aspx?hkey=8f14076c-10b8-48ab-9595-8c256836e393">purchase a subscription</a>.</em> </p> <p> If you're starting your career or considering a big employment change, your new employer may offer you a recruitment agreement to sweeten the deal. But do you know what to watch out for before you sign one? </p> <p> Recruitment agreements are contracts (separate from your employment agreement) physicians sign with hospitals, medical practices, or other employers to incentivize the physician to work where the employer is located—usually in a rural area where there is a physician shortage. To induce the physician into staying in a specified geographic area and joining the employer's medical staff, recruitment agreements often offer large signing bonuses, payments to cover relocation expenses, and guarantees to provide a minimum monthly salary. </p> <p> While these financial incentives sound appealing, recruitment agreements often carry consequences you should consider before signing. Additionally, an advisory opinion from the Centers for Medicare & Medicaid Services has stated that any subsequent changes to the terms of the recruitment agreement would likely violate the Stark Law exceptions that would normally allow employers to offer recruitment agreements. Consequently, a physician should review a recruitment agreement carefully with an experienced health care attorney to fully understand the benefits and obligations of the agreement. </p> <h3>Payments as a loan</h3> <p> On the surface, recruitment agreements appear to offer payments to augment a new physician's income, guaranteeing a certain minimum salary each month, regardless of how much the physician brings in for the employer. But these payments are actually structured as a loan or line of credit. Generally, the physician can avoid repayment by staying in the area and working for the same employer for a predetermined amount of time during which the loan is forgiven on a pro rata basis. </p> <p> Every recruitment agreement contains a section frequently called the "Guarantee of Income." To illustrate how this works, let's say the recruitment agreement promises a physician a minimum salary of $20,000 per month. This means that when the physician collects less than $20,000 in a month, the other party to the agreement will make up the difference by drawing on the line of credit. </p> <p> If the physician collects only $10,000, then the line of credit will provide the physician with an additional $10,000 to make sure the physician receives a total income of $20,000 for the month. This arrangement generally continues for 12 months, but some recruitment agreements contain Guarantee of Income terms that last for up to 36 months. </p> <p> But these payments are essentially loans that are forgiven at a steady rate so long as the physician continues to practice in the area. One way or another, the physician will have to repay this debt, either directly or by pro rata loan forgiveness. </p> <p> Recruitment agreements are written so that they comply with federal law, and as such, a physician enjoying perks such as loan forgiveness will still be required to pay applicable taxes as portions of the loan are forgiven. Such taxes will be in addition to taxes on other salary or income. This is an important consideration, and prudent physicians will consult with an attorney familiar with health law and related tax laws to fully understand how loan forgiveness might affect the taxes they're required to pay. </p> <h3>Consequences for early termination</h3> <p> Because recruitment agreements require a physician to stay in an area for a specified period, it is important for all parties to know when the agreement may be terminated, by whom, and for what reasons. The physician may be expected to immediately repay any outstanding balance on the loaned funds if he or she resigns before the loan has been completely forgiven. </p> <p> The same can be true if the hospital terminates the agreement for cause, should the employed physician violate one of many stringently enforced terms of the agreement. The result may mean that a physician who desires to move away from the area must repay tens, if not hundreds, of thousands of dollars, often immediately, to cover the accrued amount of monthly salary payments. </p> <p> Some recruitment agreements also penalize employed physicians for early termination of employment by requiring immediate repayment of relocation stipends and signing bonus amounts. Consider having a payment plan in place in case something unexpected forces you to move or change your practice. </p> <p> Recruitment agreements are common and potentially advantageous for both rural employers and physicians thinking of jump-starting their careers in a new direction. However, these agreements can have significant financial consequences, even when fully vetted and complied with. If you are considering signing a recruitment agreement, do so only after ample consideration and careful review with an experienced health care attorney. . </p> <p> <em>Tierney Edwards, JD, is WSMA's associate director of legal and federal affairs.</em> </p> </div>11/21/2018 12:00:00 AM1/1/0001 12:00:00 AM
Practice_Alerts_November_21_2018Practice Alerts: November 21, 2018Latest_NewsShared_Content/News/Practice_Alerts/Practice_Alerts_November_21_2018<div class="col-md-12"> <div class="col-md-5 pull-right"><img alt="" src="/images/Logos/Practice-Alerts-ArticleImage-Tagline_645x425.jpg" class="pull-right" /></div> <h5> November 21, 2018 </h5> <h2>Practice Alerts</h2> <p>In this issue: In this issue: Resources and guidance on new state opioid prescribing rules, Medicare preventive and wellness visits, Healthier Washington pay-for-performance metrics and much more.</p> <p>For personal assistance, contact the <a href="https://wsma.org/WSMA/Services/Physician_Practice_Helpline/WSMA/Services/Physician_Practice_Helpline/Physician_Practice_Helpline.aspx?hkey=fc908a57-5820-41dc-8a1f-e2a7b1498e3b">WSMA Physician Practice Helpline</a> by emailing Bob Perna, MBA, FACMPE, at <a href="mailto:rjp@wsma.org">rjp@wsma.org</a> or Michelle Lott, CPC, CPMA at <a href="mailto:mml@wsma.org">mml@wsma.org</a>.</p> <p>Jump to section:</p> <!-- NAVIGATION--> <p> <a href="#edu"> Educational Programs</a> </p> <p> <a href="#practice"> Practice Operations / Clinical Issues</a> </p> <p> <a href="#medicare"> Medicare / Medicare Advantage</a> </p> <p> <a href="#qpp"> Medicare / MACRA Quality Payment Program / MIPS</a> </p> <p> <a href="#state"> State Agencies - Medicaid / Healthier Washington</a> </p> <p> <a href="#commercial"> Commercial Health Insurers</a> </p> <p> <a href="#value"> Value-Based Payment</a> </p> <!-- END NAVIGATION--> <a name="edu"></a> <h3> <span style="color: #4bacc6;">EDUCATIONAL PROGRAMS</span> </h3> <h3>New free webinar: Dealing with ERISA claims; WSMA advocacy with U.S. Department of Labor</h3> <p> ERISA, the Employee Retirement Income Security Act of 1974, affects self-insured health plans. Claims payments and denials with ERISA plans are becoming increasingly problematic for physician practices. In years past, only very large companies took on self-insured health care coverage; now, insurers are marketing third-party administrator/"administrative services only" to companies as small as 50–100 employees. As the employers bear full financial risk, these arrangements are not "insurance" products regulated by the state Office of the Insurance Commissioner, meaning the OIC cannot intervene to protect those patients. However, the U.S. Department of Labor does have oversight of ERISA arrangements. </p> <p> The WSMA can assist you in two ways: first, we're collaborating with the Seattle office of the U.S. Department of Labor to offer a new webinar, ERISA and Payment of Healthcare Claims, to be held on Wednesday, Nov. 28, from noon–1 p.m. <a href="https://register.gotowebinar.com/register/4782950741761434882">Register online</a> for this free event. This presentation will provide an overview of ERISA Title I, as well as explain fully insured vs. self-insured health plans, claims procedures and participants' rights, and the role of the Department of Labor. </p> <p> The WSMA can also assist your practice, should you receive a denial or other adverse action on a submitted ERISA claim, through our advocacy on behalf of WSMA members with the U.S. Department of Labor. Please join us for this important presentation. </p> <h3>New free webinar: Understand new state opioid prescribing rules</h3> <p> On Jan. 1, Washington state's <a href="https://wsma.org/Shared_Content/News/Membership_Memo/20180912/medical_commission_finalizes_opioid_prescribing_rules.aspx">new opioid prescribing rules</a> for physicians and physician assistants treating all phases of pain (acute, subacute, and chronic) go into effect. Plan now to attend this new free WSMA webinar on Wednesday, Dec. 19 from noon–1 p.m. designed to help you understand how to comply with the new requirements. <a href="https://register.gotowebinar.com/register/1349059379828828930">Register for this free session online</a>. For questions, contact Jeb Shepard at <a href="mailto:jeb@wsma.org">jeb@wsma.org</a>. This activity has been approved for <em>AMA PRA Category 1 Credit™</em>. </p> <h3>Webinar: Medicare IPPE and AWV</h3> <p>Noridian is hosting a free webinar on Medicare's Initial Preventive Physical Examination and Annual Wellness Visit. The session will cover the IPPE - aka "Welcome to Medicare" - and the Annual Wellness Visit, documentation requirements and frequency limitations for providing these services. The webinar will be held on Wednesday, Dec. 5 at 1 p.m. Register online at the <a href="https://med.noridianmedicare.com/web/jfb/education/training-events">Noridian Schedule of Events</a>. </p> <a name="practice"></a> <h3> <span style="color: #4bacc6;">PRACTICE OPERATIONS / CLINICAL ISSUES</span> </h3> <h3>Understanding and preparing for new opioid prescribing rules </h3> <p>New opioid prescribing rules for Washington state prescribing professions, prompted by House Bill 1427 and shaped by more than a year of stakeholder input, have been adopted. The following guidance from the WSMA can assist its members, both physicians and physician assistants (allopathic and osteopathic), in understanding, preparing for, and succeeding under these new requirements.</p> <p>The comprehensive rules represent a significant change in how opioids are prescribed. Key provisions applicable to all prescribing physicians and PAs include: </p> <ul> <li>A seven-day pill limit for acute prescriptions and 14 days for acute operative pain, with an exemption to these limits when clinical judgment is documented in the medical record.</li> <li>A specific care plan and documentation requirements for each phase of pain. </li> <li>Mandated registration and targeted checks of the prescription drug monitoring program. </li> <li>Required continuing medical education on opioid prescribing.</li> </ul> <p>As the state's regulatory bodies adopted under their own authority, there are several differences between the rules for each profession. For allopathic physicians and physician assistants, the new prescribing rules go into effect Jan. 1; new rules for osteopathic physicians and PAs went into effect on Nov. 1. For more on the differing requirements between Washington Medical Commission and the Board of Osteopathic Medicine and Surgery rulemaking, see this <a href="https://www.doh.wa.gov/Portals/1/Documents/631073-OverviewHandout-Pharmacy.pdf?ver=2018-10-04-151450-403">Table of Differences</a> from the Department of Health.</p> <p>How to prepare:</p> <ul> <li>Register to attend WSMA's free one-hour webinar, Understanding New State Opioid Prescribing Rules, on Wednesday, Dec. 19, noon–1 p.m., designed to help you understand how to comply with the new requirements. <a href="https://register.gotowebinar.com/register/1349059379828828930">Register for the webinar online</a>. This activity has been approved for <em>AMA PRA Category 1 Credit™</em>. Attendance will fulfill the new state requirement for continuing medical education on opioid prescribing.</li> <li>Set up your account with Washington state's prescription monitoring program, <a href="http://www.wapmp.org/">Prescription Review</a>. Prescription Review uses a secure platform to allow a prescribing physician to access crucial patient information before prescribing, such as duplicate prescribing, misuse, drug interactions, and other potential concerns. Don't wait until the last minute—get started today setting up your account. The DOH website has a <a href="https://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/HealthcareProfessionsandFacilities/PrescriptionMonitoringProgramPMP#dnn_ctr32065_FAQs_lstFAQs_Q2_0">section with instructions for physicians, including video tutorials</a>. </li> </ul> <p>Also, the WSMA has joined the Washington State Hospital Association to reach out to hospital and health system leaders, encouraging them to work with their IT departments to build edits and prompts into electronic health records that assist clinicians with compliance under the rules. </p> <p>For more information on the new rules and other WSMA efforts to assist physicians and other clinicians with safe opioid prescribing, visit the <a href="https://wsma.org/WSMA/Resources/Clinical_Quality/Opioid_Clinical_Guidance/WSMA/Resources/Clinical_Quality/Opioid_Clinical_Guidance/Opioid_Clinical_Guidance.aspx?hkey=1f82f660-18a4-4be3-bb2f-6b454b6eb7cd">WSMA's Opioid Clinical Guidance webpage</a> </p> <h3>The Physicians Foundation's biennial survey results released </h3> <p>The Physicians Foundation recently released the results of its 2018 survey of U.S. physicians, which reveal the impact of factors driving physicians to reassess their careers. The survey, administered by Merritt Hawkins, includes responses from nearly 9,000 physicians across the country. </p> <p>The findings underscore the overall impact of excessive regulatory/insurer requirements, loss of clinical autonomy, and challenges with electronic health record design/interoperability on physician attitudes toward their medical practice environment and overall dissatisfaction—all of which have led to professional burnout. </p> <p><a href="https://physiciansfoundation.org/wp-content/uploads/2018/09/physicians-survey-results-final-2018.pdf" target="_blank">Review the full survey report</a>. The WSMA is a signatory society of the Physicians Foundation, a nonprofit 501(c)(3) organization that seeks to empower physicians. </p> <h3>Free life insurance policy locator</h3> <p>The <a href="https://eapps.naic.org/life-policy-locator/#/welcome">Life Insurance Policy Locator</a> helps connect consumers with lost life insurance policies or annuities. Available through the National Association of Insurance Commissioners, in its initial two years, the locator has matched nearly 25,000 consumers with policies totaling $368 million nationwide. Washington state consumers located policies totaling $7.3 million in the past two years.</p> <a name="medicare"></a> <h3> <span style="color: #4bacc6;">MEDICARE / MEDICARE ADVANTAGE</span> </h3> <h3>New 2019 Opioid Safety Edits for UHC's Medicare Advantage and prescription drug plans</h3> <p> Beginning Jan. 1, UnitedHealthcare's Medicare Advantage and Prescription Drug Plans will be implementing several new point-of-service safety edits to help cut down on the prevalence of opioid misuse and address safety concerns around opioid prescriptions. To better understand these edits and any actions needed, review UHC's <a href="https://www.uhcprovider.com/content/dam/provider/docs/public/resources/pharmacy/MEDADV-Opioid-Readiness-QRG.pdf" target="_blank">2019 Opioid Readiness: Quick Reference Guide for UnitedHealthcare Medicare Advantage and Prescription Drug Plans</a>. </p> <h3>Medicare Advantage: Opioid prescribing in 2019</h3> <p> WSMA staff are researching imminent changes on opioid prescribing in the Medicare Advantage program. Under provisions of the <strong>Comprehensive Addiction and Recovery Act of 2016</strong>, effective Jan. 1, Medicare Advantage plans will be allowed to apply prescribing restrictions on opioids and benzodiazepines. For example, United Healthcare has posted on its website a 2019 Opioid Readiness: Quick Reference Guide, and will include related information in its November provider network bulletin. United Healthcare advises it also has sent a detailed notification letter to its participating providers. </p> <p> WSMA staff are reviewing this matter with CMS Region 10 representatives. CMS' webpage <a href="https://www.cms.gov/Medicare/Prescription-Drug-coverage/PrescriptionDrugCovContra/RxUtilization.html">Improving Drug Utilization Review Controls in Part D</a> provides some further background, yet that webpage currently includes an "Under Construction" reference for 2019 guidance. The WSMA will provide further details as those become available. For questions on Medicare Advantage, contact Bob Perna at <a href="mailto:rjp@wsma.org">rjp@wsma.org</a>. For questions on Washington state prescribing rules, contact Jeb Shepard at <a href="mailto:jeb@wsma.org">jeb@wsma.org</a>. </p> <h3>New Medicare card mailing; Some have received two cards!</h3> <p> The Centers for Medicare & Medicaid Services (CMS) has advised that some Medicare patients have inadvertently received two of the new Medicare cards. In some cases, patients received two cards with the same new alpha-numeric Medicare beneficiary identifier (MBI). However, some patients received two cards with different identification numbers. Any patients who received two cards should be instructed to call 1.800.MEDICARE (1.800.633.4227). </p> <p> If your Medicare patients say they did not get a card, ask them to: </p> <ul> <li>Call 1.800.MEDICARE (1.800.633.4227). There might be something that needs to be corrected, such as updating their mailing address.</li> <li>Sign into MyMedicare.gov to see if CMS mailed their card. If so, they can print an official card. They must create an account if they do not already have one.</li> </ul> <p> Practices can use either the former Social Security number-based health insurance claim number or the new alpha-numeric Medicare beneficiary identifier (MBI) for all Medicare transactions through Dec. 31, 2019. Direct your Medicare patients to <a href="https://www.medicare.gov/NewCard">Medicare.gov/NewCard</a> for information about the mailings and to sign up to get email updates on the status of card mailings. Practice staff should become familiar with using the new online <a href="https://med.noridianmedicare.com/web/jfb/article-detail/-/view/10534/mbi-look-up-tool-available-on-the-noridian-medicare-portal">MBI Look-Up Tool</a> which is available on <a href="https://www.noridianmedicareportal.com/">Noridian's secure portal</a>. </p> <a name="qpp"></a> <h3> <span style="color: #4bacc6;">MEDICARE / MACRA QUALITY PAYMENT PROGRAM / MIPS</span> </h3> <h3>Quality Payment Program Year 1 Performance Results</h3> <p>CMS released 2017 performance data for the Quality Payment Program. CMS announced the preliminary data earlier this year, and is now releasing additional data that show significant success and participation in both the Merit-based Incentive Payment System and Advanced Alternative Payment Model tracks. For a complete breakdown of the 2017 performance data, see the <a href="https://www.cms.gov/blog/quality-payment-program-qpp-year-1-performance-results">blog</a> and <a href="https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2017-QPP-Performance-Data-Infographic.pdf" target="_blank">infographic</a>.</p> <h3>Quality Payment Program: Participation Status Tool Updated</h3> <p>CMS updated the Quality Payment Program <a href="https://qpp.cms.gov/participation-lookup">Participation Status Tool</a> based on calculations from the second snapshot of Medicare Part B claims data to calculate the Alternative Payment Model (APM) entities threshold scores. The second snapshot is for dates of participation between Jan. 1 and June 30, 2018. The tool includes 2018 Qualifying APM Participant (QP) and Merit-based Incentive Payment System APM status.</p> <h3>Quality Payment Program: Advanced APMs online training course</h3> <p> An updated web-based training course, Quality Payment Program in 2018: Advanced, is now available through CMS' <a href="https://learner.mlnlms.com/Default.aspx">Medicare Learning Network – Learning Management System website</a>. The program covers Advanced Alternative Payment Models (APMs), including how to identify an Advanced APM and a CMS Advanced APM, as well as how to participate in the QPP via an Advanced APM. </p> <p> CMS designates this enduring material for a maximum of 0.5 <em>AMA PRA Category 1 Credits™</em>. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Credit for this course expires October 23, 2021. <em>AMA PRA Category 1 Credit ™ is a trademark of the American Medical Association</em>. </p> <a name="state"></a> <h3> <span style="color: #4bacc6;">STATE AGENCIES – MEDICAID / HEALTHIER WASHINGTON</span> </h3> <h3>Healthier Washington: WSMA Guide for Physician Practices</h3> <p> Our state's <a href="http://www.hca.wa.gov/about-hca/healthier-washington">Healthier Washington</a> initiatives comprise a "demonstration project" – not a grant – funded by the federal Centers for Medicare & Medicaid Services, intended to transform care delivery, starting with the Medicaid program. </p> <p> The project runs from 2017-21. The Health Care Authority will receive funding from CMS, contingent upon achieving specific targets, framed around <a href="https://www.hca.wa.gov/about-hca/healthier-washington/medicaid-transformation-resources">three core strategies</a>: </p> <ul> <li>Improving how health care services are paid (value-based payment).</li> <li>Ensuring that health care focuses on the whole person (care integration).</li> <li>Build healthier communities through a collaborative approach (through nine regional Accountable Communities of Health - ACHs).</li> </ul> <p> Each of the nine ACHs have selected "projects" to address the transformation of care, including two required projects: Integration of Physical and Behavioral Health, and Addressing the Opioid Use Public Health Crisis. </p> <p> Physicians and their practices can consider participating in this dramatic redesign of care delivery to Medicaid patients and the incremental introduction of value-based payment methodologies, replacing traditional fee-for-service payments. However, these models of care and payment can be complex and confusing. </p> <p> To assist you in this process, we have prepared the <strong>Healthier Washington: WSMA Guide for Physician Practices</strong>. The Guide describes in detail the three Initiatives, along with the various projects being undertaken regionally by the nine ACHs. The Guide also explains the value-based payment models that can be used to reimburse physicians and practices for their participation in the selected projects. These payments are separate and distinct from payments made by managed care organizations for the traditional Medicaid services. </p> <p> Visit our new Healthier Washington page under our Health Insurers section to download a copy of the guide. If you have any questions about the guidance, contact Bob Perna (<a href="mailto:rjp@wsma.org">rjp@wsma.org</a>) or Michelle Lott (<a href="mailto:mml@wsma.org">mml@wsma.org</a>) at the WSMA Practice Resource Center. </p> <h3>HCA launches updated Healthier Washington Measures Dashboard </h3> <p>The Health Care Authority has released its updated Healthier Washington Measures Dashboard. The interactive dashboard allows users to explore state population and measures data, which helps support accountable communities of health (ACHs), local health jurisdictions, and communities by providing information to assess regional health needs, engage in planning for health improvement, and monitor outcomes over time.</p> <p>The dashboard shows ACHs' project pay-for-performance (P4P) metrics in the Medicaid Transformation effort: </p> <ul> <li>Over 20 new measures and sub-measures.</li> <li>Updated specifications for existing measures to align with P4P requirements. </li> <li>A new dashboard tab, Transformation Measures, which displays baseline, improvement targets, and current measure rates for some P4P measures, by project area and ACH region.</li> <li>New data dimensions, including two types of race/ethnicity breakouts and additional age group filters.</li> </ul> <p><a href="https://fortress.wa.gov/t/51/views/HealthierWashingtonDashboard/FrontPage?:isGuestRedirectFromVizportal=y&:embed=y">Access the dashboard online</a>; select “Transformation Measures.” Information about ACHs' P4P metrics and improvement targets for Medicaid Transformation year 3 (2019) are available on the <a href="https://www.hca.wa.gov/about-hca/healthier-washington/medicaid-transformation-metrics">Medicaid Transformation metrics</a> webpage. Further details on how accountability is measured under the Medicaid Transformation effort can be found in the <a href="https://www.hca.wa.gov/assets/program/mtp-measurement-guide.pdf" target="_blank">Measurement Guide</a>.</p> <a name="commercial"></a> <h3> <span style="color: #4bacc6;">COMMERCIAL HEALTH INSURERS</span> </h3> <h3>UnitedHealthcare: Provider education sessions</h3> <p>UHC is convening provider education sessions, offering updates on UHC policies and products, including commercial, Medicare Advantage, and Community Plan (Medicaid). <a href="https://uhs.cvent.com/2018ProviderTownHalls">Register online</a>. Pre-registration is required as space is limited. Each session runs about two hours. Check-in is 30 minutes before the meeting start time. Remaining dates are Astoria on Dec. 3, 1:30-3:30 p.m., and Lacey/Olympia on Dec. 4, 9-11 a.m. </p> <h3>UHC peer comparison reports now available</h3> <p> Peer comparison reports, previously known as performance reports, offer an analysis of how a physician's risk-adjusted claims data compares with that of others in the same specialty for certain key measures over a period of time. A report will be provided to UnitedHealthcare network physicians when their paid claims show trends that are statistically different from expected practice patterns. </p> <p> Physicians will receive a letter early this month that gives instructions on how to access their peer comparison reports online through Document Vault on Link. Physicians can access Document Vault by signing in to Link through <a href="https://www.uhcprovider.com/">UHCprovider.com</a>. </p> <a name="value"></a> <h3> <span style="color: #4bacc6;">VALUE-BASED PAYMENT</span> </h3> <h3>Value-based payment models: updated AMA/RAND study</h3> <p> Concerns over the feasibility of physician practices' adopting value-based payment models prompted the AMA to commission the RAND Corporation to update its 2014 study on payment models. The <a href="https://www.rand.org/pubs/research_reports/RR2667.html">new study</a>, released in October 2018, presented these findings: </p> <ul> <li>Payment models are changing at an accelerating pace, making it difficult to adapt and keep pace.</li> <li>While payment models are increasingly complex, practices that invested in understanding complex alternative payment models (APMs) found opportunities to earn financial rewards for their preexisting quality, without materially changing patient care. </li> <li>Risk aversion is more prominent among physician practices, avoiding downside risk or off-loading downside risk to partner organizations when possible. </li> </ul> <h3>Succeeding in value-based payment</h3> <p> The WSMA can help our members and their practice staff succeed with value-based payment models through our three tiers of guidance and services. </p> <h4>Tier 1: Reference materials</h4> <p> For foundational knowledge on value-based payment, review AMA's online module <a href="https://www.stepsforward.org/modules/value-based-care">Preparing Your Practice for Value-Based Care</a>. </p> <h4>Tier 2: Educational programs</h4> <p> <a href="https://wsma.org/WSMA/Resources/Practice_Management/OnDemand/Webinars_OnDemand.aspx#vbptakeaction">Value-Based Payment, MACRA/MIPS, Healthier Washington – Take Action Now!</a></p> <p> Both Medicare's MACRA Quality Payment Program and the state's Healthier Washington initiatives are built around value-based payment models. This free 45-minute OnDemand webinar, presented by the WSMA and Attune Healthcare Partners, provides an overview of the value-based payment models currently in play and focuses on specific actions to consider. </p> <h4>Tier 3: Practice-specific engagements</h4> <p> The WSMA and Attune Healthcare Partners have partnered to offer practice-specific consulting engagements to our members on value-based transformation strategies. </p> <p> For more information on the new service, review our free OnDemand webinar <a href="https://wsma.org/WSMA/Resources/Practice_Management/OnDemand/Webinars_OnDemand.aspx#path">Mapping Your Path to Value-Based Care</a>. The webinar addresses: The Problem with Payment Change; The Solution: A Customized Map to Value based care; How the Process Works, Advantages & Results. </p> <p> For more information on WSMA's value-based payment guidance, contact Michelle Lott at <a href="mailto:mml@wsma.org">mml@wsma.org</a>. </p> </div>11/20/2018 12:00:00 AM1/1/0001 12:00:00 AM
weekly_rounds_2018_11_19_difficult_news_that_must_be_deliveredWeekly Rounds: November 19, 2018 - Difficult news that must be deliveredLatest_NewsShared_Content/News/Weekly_Rounds/2018/weekly_rounds_2018_11_19_difficult_news_that_must_be_delivered<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="Weekly Rounds logo" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /></div> <h5>November 19, 2018</h5> <h2>Difficult news that must be delivered</h2> <p> Jennifer Hanscom, Executive Director/CEO </p> <p> As physicians, you're no strangers to having to dispense difficult news. It's a burden you carry with grace, compassion, and empathy. As I write today's column, that aspect of your caring profession weighs heavy on my mind. In thinking about it, I came across <a href="https://www.medicalnewstoday.com/articles/318067.php">this quote</a> on the topic, from Steven Pantilat, MD, founding director of the Palliative Care Program at the University of California-San Francisco Medical Center: "No matter how well you deliver bad news, it's still bad. You can't make it somehow OK for the patient, but it's important not to make it worse." </p> <p> These thoughts have been with me as I've considered all the ways we can make sure you're aware of how opioid prescribing rulemaking from House Bill 1427, passed by the Legislature in 2017, will ultimately impact you. Despite our efforts, the rules—which, for most of you, will be effective starting in January—are complicated and will be a challenge for some practices to implement. </p> <p> Here's some background: Combatting the opioid epidemic is a top priority for the WSMA. Over the past several years, we have advanced both <a href="https://wsma.org/Shared_Content/News/Weekly_Rounds/2018/multi_pronged_efforts_seek_to_make_a_difference_in_opioid_epidemic">legislative</a> and <a href="https://wsma.org/Shared_Content/News/Press_Releases/2018/Public-private_safe_prescribing_initiative_results_in_reductions_in_Medicaid_opioid_prescriptions.aspx">patient-safety strategies</a>, partnering with the Washington State Hospital Association, the governor's office, the state Department of Health, and the state Health Care Authority. </p> <p> You'll recall that over the last year, we've <a href="https://wsma.org/Shared_Content/News/Membership_Memo/20180912/medical_commission_finalizes_opioid_prescribing_rules.aspx">regularly</a> <a href="https://wsma.org/Shared_Content/News/Membership_Memo/20180808/Last_chance_to_comment_on_rules_impacting_the_way_you_prescribe_opioids">communicated</a> our <a href="https://wsma.org/Shared_Content/News/Membership_Memo/20180228/doh_seeks_comments_on_draft_opioid_prescribing_rules_final_public_meeting_on_march_14">efforts</a> regarding the rulemaking on this bill. It's been an exceedingly rough road, as five separate medical commissions proposed varying—and sometimes conflicting—rules, over many iterations. Throughout the process, our team in Olympia has heroically had your backs, and has been unceasingly vigilant in working to protect you from undue burden and your patients from unintended consequences. </p> <p> At the same time, as a leading voice for the physician community, the WSMA has advocated for policies that reduce the amount of inappropriate prescriptions in our communities while ensuring access to medications for patients that need them. </p> <p> House Bill 1427 became the primary vehicle for many interventions, including opioid prescribing rules and data sharing by the state to improve opioid prescribing practices. After a year-long process, the boards and commissions that regulate prescribers in Washington state have finalized their rules. For allopathic physicians and physician assistants, Washington Medical Commission's final rules go into effect this Jan. 1 (read the final rule <a href="https://wmc.wa.gov/sites/default/files/public/documents/Ruleswithcoverpage.pdf" target="_blank">here</a>). For osteopathic physicians and PAs, Board of Osteopathic Medicine and Surgery rules went into effect on Nov. 1 (read that final rule <a href="https://www.doh.wa.gov/Portals/1/Documents/2300/2018/WSR-18-20-087.pdf" target="_blank">here</a>). </p> <p> As medical leaders, you will want to note the prescribing professions' differing requirements, given HB 1427 allowed each regulatory body to adopt new rules under its own authority. At the request of several leaders, we are working to create a rules overview slide deck that will help you prepare your care teams for these new requirements (we expect the slides to be ready in December). </p> <p> For now, together with Washington State Hospital Association and the Health Care Authority, we are recommending three key strategies for success in this new opioid prescribing environment: </p> <ul> <li><a href="https://wsma.org/WSMA/Resources/Clinical_Quality/Opioid_Clinical_Guidance/Opioid_Clinical_Guidance.aspx#rules">Prepare for new opioid prescribing rules</a>.</li> <li><a href="https://wsma.org/WSMA/Resources/Clinical_Quality/Opioid_Clinical_Guidance/Opioid_Clinical_Guidance.aspx#data">Leverage available data to understand prescribing patterns and receive alerts for patients who have experienced an overdose</a>. </li> <li><a href="https://wsma.org/WSMA/Resources/Clinical_Quality/Opioid_Clinical_Guidance/Opioid_Clinical_Guidance.aspx#pmp">Integrate your electronic health record with the state's prescription monitoring program</a>. </li> </ul> <p> The links above contain details on these strategies and recommendations. You will need to develop a comprehensive strategy for engaging in this work, and I know it won't be easy. I'm chagrined at being one of the messengers on this news, but I appreciate your response to the opioid epidemic. </p> <p> I hope you know that we are fully committed caring for, and protecting you, just as you do for your patients. We'll keep working hard to prevent well-intentioned, yet problematic concepts for patient care. </p> <p> Thank you for all you do on behalf of Washington patients. </p> </div>11/19/2018 12:00:00 AM1/1/0001 12:00:00 AM
wsma_reports_reducing_unnecessary_testingWSMA Reports: Reducing unnecessary testingLatest_NewsShared_Content/News/Reports/2018/wsma_reports_reducing_unnecessary_testing<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/WSMA-Reports%20article%20graphic-2018-NovDec.jpg" class="pull-right" /></div> <h5>November 19, 2018</h5> <h2>Reducing unnecessary testing</h2> <p> BY JESSICA MARTINSON </p> <p> <em>The following article was featured in the November/December 2018 issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may <a href="https://wsma.org/WSMA/News_Publications/Publications/WSMA/News_Publications/Publications/Publications.aspx?hkey=8f14076c-10b8-48ab-9595-8c256836e393">purchase a subscription</a>.</em> </p> <p> John H. Vassall, MD, recently spoke with "a very thoughtful and efficient family physician" about a patient who was preparing for a total knee replacement. </p> <p> The patient had come to her office with a request from the orthopedic surgeon for a preoperative evaluation and testing, including a CBC, EKG, and a nasal swab for MRSA. Dr. Vassall asked if she thought the CBC and EKG were indicated. </p> <p> "She was initially puzzled by my question, but after some reflection, admitted that neither was likely to add value to this patient's care," said Dr. Vassall, who is physician executive for quality and safety at Qualis Health, a board member of the WSMA Foundation for Health Improvement, and a member of the Washington State Choosing Wisely Task Force. </p> <p> So why would she order the tests? </p> <p> "My colleague sees between 20 and 30 patients a day," Dr. Vassall said. "She must make about 10 decisions per patient, which means 200 to 300 decisions per day. Sending the patient for the requested tests requires only one decision; evaluating the need for each of the three tests increases her mental workload to four decisions, and involves an additional discussion with the patient, adding more time and effort. Her professional survival involves simplifying her workload and reducing the number of decisions. Add to that the prospect of explaining to her colleague why she did not follow his instruction and you can see that this becomes onerous. </p> <p> "Of necessity, we must do many things by standardized routine," Dr. Vassall noted. "However, it's time for us to reevaluate some of the testing we order prior to low-risk, elective procedures on healthy patients." </p> <p> That is the message of "Drop the Pre-Op," an initiative of the Washington State Choosing Wisely Task Force, which is co-sponsored by the WSMA, the Washington Health Alliance, and the Washington State Hospital Association. The initiative is a result from this year's report from the Washington Health Alliance, "First, Do No Harm: Calculating Health Care Waste in Washington State." The report found that at least 100,000 patients received unnecessary pre-op testing during a one-year period, at a statewide estimated cost of more than $92 million. </p> <p> Naturally, physicians are well-intentioned in ordering the tests. They want to be thorough and they don't want a patient to be turned away on the day of surgery. Drop the Pre-Op points out that physicians agree that all patients need preoperative evaluation, but a low-risk patient having a low-risk procedure does not need pre-op testing. </p> <p> The task force is spreading the word to the state's health care community about Drop the Pre-Op through a variety of channels, including an information sheet, PowerPoint decks to use at a staff meeting or during grand rounds, and more, all available on our <a href="https://wsma.org/WSMA/Resources/Clinical_Quality/Choosing_Wisely/WSMA/Resources/Clinical_Quality/Choosing_Wisely/Choosing_Wisely.aspx?hkey=c623a808-1091-4ae4-98b7-fe7df46d01e7">Choosing Wisely page</a> (in the Physician Tool Kit). </p> <p> If you need additional information or resources on Drop the Pre-Op, contact me at <a href="mailto:jessica@wmsa.org">jessica@wmsa.org</a>. </p> <p> <em>Jessica Martinson is WSMA's director of clinical education and professional development.</em> </p> </div>11/19/2018 12:00:00 AM1/1/0001 12:00:00 AM
A_closer_look__Gun_violence_policies_adopted_by_WSMA_House_of_DelegatesA closer look: Gun violence policies adopted by WSMA House of DelegatesLatest_NewsShared_Content/News/Membership_Memo/20181114/A_closer_look__Gun_violence_policies_adopted_by_WSMA_House_of_Delegates<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/Concepts/gun_storage_645x425.jpg" class="pull-right" /> </div> <h5> November 14, 2018 </h5> <h2>A closer look: Gun violence policies adopted by WSMA House of Delegates</h2> <p>In the wake of two horrific mass shooting events - the killing of twelve people by a gunman in Thousand Oaks, Calif. and the massacre by a gunman of 11 congregants at a Pittsburgh synagogue - it's worth pausing a moment to consider the physicians and providers who have a front-row seat to the carnage created by gun violence. Physicians work tirelessly to reduce the impact of gun violence on bodies, and here in Washington state, they are also working to reduce the frequency of gun violence by seeking policy changes at the federal, state, and local level.</p> <p>During last month's WSMA Annual Meeting, the WSMA House of Delegates adopted a total of 10 new policies related to gun violence (Resolutions C-9 through 14). They are: </p> <ul> <li>RESOLVED, that the WSMA advocate for measures to reduce gun violence. </li> <li>RESOLVED, that the WSMA support the elimination of laws intruding on physicians’ and patients’ rights to discuss gun violence. </li> <li>RESOLVED, that the WSMA support encouraging physicians and health care workers to discuss safe storage of guns and the association of guns with risk of homicide, accidental shooting, and suicide, and counsel about risk. </li> <li>RESOLVED, that the WSMA support closing loopholes in gun purchases online and at unregulated gun shows. </li> <li>RESOLVED, that the WSMA support policy that creates weapons-free zones for medical practice settings, allowing exceptions for law enforcement. </li> <li>RESOLVED, that the WSMA support policy to address firearm-related violence and injury as a public health issue. </li> <li>RESOLVED, that the WSMA support policy that provides for background checks and waiting periods for the purchase of firearms. </li> <li>RESOLVED, that the WSMA support policy that will encourage and promote the safe storage of firearms in homes where those firearms are kept. </li> <li>RESOLVED, that the WSMA support policy that raises the minimum age to purchase a firearm to 21 years of age. </li> <li>RESOLVED, that the WSMA encourage its members to screen for risk factors of firearm injury and educate patients about prevention and safe storage. </li> </ul> <p>In addition to those new policies, WSMA delegates also reaffirmed existing policy that calls on the WSMA to support appropriate legislation that would restrict the sale and private ownership of large-clip, high-rate-of-fire automatic and semi-automatic firearms. Finally, WSMA delegates directed the WSMA to urge the state and federal government to fund research on the causes and prevention of firearm violence and injury and ensure that the databases and systems necessary for research and public health surveillance are available and publicly accessible.</p> <p>Washington's citizens are acting too: during this year's midterm election, voters passed Initiative 1639, which appears to largely align with WSMA policy requiring safe storage and restricting the purchase of firearms under certain circumstances.</p> <p>The creation of strong policy is at the heart of the WSMA's work, and reflects a commitment from Washington physicians to the health and welfare of patients and communities that extends beyond the exam room. Find all the new policies adopted by the 2018 WSMA House of Delegates on the <a href="[@]WSMA/About/Leadership/House_of_Delegates/House_of_Delegates.aspx">House of Delegates page</a>. For a comprehensive list of House of Delegates policy, review the WSMA Policy Compendium on our <a href="[@]WSMA/About/Policies/Policies.aspx">Policies page</a>.</p> </div>11/14/2018 3:00:35 PM1/1/0001 12:00:00 AM
cms_releases_final_rule_on_medicares_physician_fee_schedule_for_2019CMS releases final rule on Medicare’s physician fee schedule for 2019Latest_NewsShared_Content/News/Membership_Memo/20181114/cms_releases_final_rule_on_medicares_physician_fee_schedule_for_2019<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/People%20non%20stock/Medicare_asclepius_lo-res_645x425.jpg" class="pull-right" /> </div> <h5 style="font-size: 14px;">November 14, 2018</h5> <h2>CMS releases final rule on Medicare's physician fee schedule for 2019</h2> <p> The Centers for Medicare & Medicaid Services has issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under Medicare's physician fee schedule on or after Jan 1. The rule includes changes to E/M documentation guidelines strongly supported by the WSMA and the rest of organized medicine, and in further good news, delays implementation of CMS' proposal to collapse Medicare payment rates for office and outpatient visit services. </p> <p> Key points in the final rule include: </p> <ul> <li>The final 2019 conversion factor, with the budget neutrality adjustment to account for changes in RVUs (all required by law), is $36.04, a slight increase above the 2018 conversion factor of $35.99.</li> <li>The blended reimbursement rate for evaluation and management (E&M) levels of service 99202-99204 and 99212-99215 will be implemented in 2021—so you have two years to ramp up*. The Level 5 service is NOT included in this blended rate due to concerns of care for complex patients being impacted.</li> <li>The payment reduction on second procedure using the 25 modifier did not pass.</li> <li>The G codes proposed for podiatric services were not formally adapted as part of the final rule.</li> <li>The proposed new G codes for primary care services, specialty services, and extended care (formerly known as prolonged physician services) were accepted as part of the final rule for implementation in 2021.</li> <li>For E/M office/outpatient visits for new and established patients, practitioners need not re-enter in the medical record information on the patient's chief complaint and history that has already been entered by ancillary staff or the beneficiary. The practitioner may simply indicate in the medical record that he or she reviewed and verified this information; and</li> <li>Removal of potentially duplicative requirements for notations in medical records that may have previously been included in the medical records by residents or other members of the medical team for E/M visits furnished by teaching physicians. </li> <li>CMS has finalized a policy that, effective Jan. 1, wholesale acquisition cost (WAC)-based payments for Part B drugs determined under section 1847A of the Social Security Act, during the first quarter of sales when the average sale price (ASP) is unavailable, will be subject to a 3 percent add-on in place of the 6 percent add-on that is currently being used. We would also like to reiterate that these changes only apply to WAC-based payment for new Part B drugs.</li> </ul> <p> *For 2021, CMS is proposing two basic payment rates for office visit services, one for straightforward visits and another for complex visits. In addition, CMS noted its intent to propose add-on codes for primary care and inherently complex specialty E/M visits. CMS said they will also consider input from the AMA and others in medical community. </p> <p> We're grateful to the AMA for its quick analysis of the E/M sections of the final rule and for <a href="https://wsma.org/Shared_Content/News/Latest_News/2018/September/WSMA_joins_AMA_to_raise_concerns_on_proposed_changes_to_E_M_codes">leading the nationwide coordinated effort</a> to oppose the problematic proposals offered by CMS. </p> <p> For questions, contact Michelle Lott at <a href="mailto:mml@wsma.org">mml@wsma.org</a>. </p> </div>11/14/2018 12:00:00 AM1/1/0001 12:00:00 AM
the_physicians_foundations_biennial_survey_results_releasedThe Physicians Foundation’s biennial survey results releasedLatest_NewsShared_Content/News/Membership_Memo/20181114/the_physicians_foundations_biennial_survey_results_released<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/Phyicians_Foundation_physicians-survey-results-final-2018_645x425.jpg" class="pull-right" /> </div> <h5> November 14, 2018 </h5> <h2>The Physicians Foundation's biennial survey results released</h2> <p> The Physicians Foundation recently released the results of its 2018 survey of U.S. physicians, which reveal the impact of factors driving physicians to reassess their careers. The survey, administered by Merritt Hawkins, includes responses from nearly 9,000 physicians across the country and underscores the overall impact of excessive regulatory/insurer requirements, loss of clinical autonomy, and challenges with electronic health record design/interoperability on physician attitudes toward their medical practice environment and overall dissatisfaction—all of which have led to professional burnout. <a href="https://physiciansfoundation.org/wp-content/uploads/2018/09/physicians-survey-results-final-2018.pdf" target="_blank">Review the full survey report</a>. The WSMA is a signatory society of the Physicians Foundation, a nonprofit 501(c)(3) organization that seeks to empower physicians. </p> </div>11/14/2018 12:00:00 AM1/1/0001 12:00:00 AM
understanding_and_preparing_for_new_opioid_prescribing_rulesUnderstanding and preparing for new opioid prescribing rulesLatest_NewsShared_Content/News/Membership_Memo/20181114/understanding_and_preparing_for_new_opioid_prescribing_rules<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/Opiod_Clinical_Guidance_prescription_pad_645px.jpg" class="pull-right" /> </div> <h5> November 14, 2018 </h5> <h2>Understanding and preparing for new opioid prescribing rules</h2> <p> New opioid prescribing rules for Washington state prescribing professions, prompted by House Bill 1427 and shaped by more than a year of stakeholder input, have been adopted. The following guidance from the WSMA can assist members, both physicians and physician assistants (allopathic and osteopathic), in understanding, preparing for, and succeeding under these new requirements. </p> <p> The comprehensive rules represent a significant change in how opioids are prescribed. Key provisions applicable to all prescribing physicians and PAs include: </p> <ul> <li>A seven-day pill limit for acute prescriptions and 14 days for acute operative pain, with an exemption to these limits when clinical judgment is documented in the medical record. </li> <li>A specific care plan and documentation requirements for each phase of pain. </li> <li>Mandated registration and targeted checks of the prescription drug monitoring program.</li> <li>Required continuing medical education on opioid prescribing. </li> </ul> <p> As the state's regulatory bodies adopted under their own authority, there are several differences between the rules for each profession. For allopathic physicians and physician assistants, the new prescribing rules go into effect Jan. 1; new rules for osteopathic physicians and PAs went into effect on Nov. 1. For more on the differing requirements between Washington Medical Commission and the Board of Osteopathic Medicine and Surgery rulemaking, see this <a href="https://www.doh.wa.gov/Portals/1/Documents/631073-OverviewHandout-Pharmacy.pdf?ver=2018-10-04-151450-403">Table of Differences</a> from the Department of Health. </p> <p> How to prepare: </p> <ul> <li> Register to attend WSMA's free one-hour webinar, Understanding New State Opioid Prescribing Rules, on Wednesday, Dec. 19, noon–1 p.m., designed to help you understand how to comply with the new requirements. <a href="https://register.gotowebinar.com/register/1349059379828828930">Register for the webinar online</a>. This activity has been approved for <em>AMA PRA Category 1 Credit™</em>. Attendance will fulfill the new state requirement for continuing medical education on opioid prescribing. </li> <li> Set up your account with Washington state's prescription monitoring program, <a href="http://www.wapmp.org/">Prescription Review</a>. Prescription Review uses a secure platform to allow a prescribing physician to access crucial patient information before prescribing, such as duplicate prescribing, misuse, drug interactions, and other potential concerns. Don't wait until the last minute—get started today setting up your account. The DOH website has a <a href="https://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/HealthcareProfessionsandFacilities/PrescriptionMonitoringProgramPMP#dnn_ctr32065_FAQs_lstFAQs_Q2_0">section with instructions for physicians, including video tutorials</a>. </li> </ul> <p> Also: The WSMA has joined the Washington State Hospital Association to reach out to hospital and health system leaders, encouraging them to work with their IT departments to build edits and prompts into electronic health records that assist clinicians with compliance under the rules. </p> <p> For more information on the new rules and other WSMA efforts to assist physicians and other clinicians with safe opioid prescribing, visit the WSMA's <a href="https://wsma.org/WSMA/Resources/Clinical_Quality/Opioid_Clinical_Guidance/WSMA/Resources/Clinical_Quality/Opioid_Clinical_Guidance/Opioid_Clinical_Guidance.aspx?hkey=1f82f660-18a4-4be3-bb2f-6b454b6eb7cd">Opioid Clinical Guidance webpage</a>. </p> </div>11/14/2018 12:00:00 AM1/1/0001 12:00:00 AM
worlddiabetesday_how_you_can_help_prevent_diabetes_in_washington_state#WorldDiabetesDay: How you can help prevent diabetes in Washington stateLatest_NewsShared_Content/News/Membership_Memo/20181114/worlddiabetesday_how_you_can_help_prevent_diabetes_in_washington_state<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/diabetes_stop_645x425.jpg" class="pull-right" /> </div> <h5> November 14, 2018 </h5> <h2>#WorldDiabetesDay: How you can help prevent diabetes in Washington state</h2> <p> Today, in support of World Diabetes Day, the WSMA, in partnership with the AMA, is launching an effort to help prevent diabetes in our state and to increase patient participation in diabetes prevention programs. This is part of a strategic effort to reach more patients with prediabetes and to slow the progression of type 2 diabetes. </p> <p> The Centers for Disease Control and Prevention estimates that 30 million adult Americans have diabetes, or approximately 10 percent of the adult population. Even more adults are at risk for developing diabetes, with the CDC estimating that 84 million adult Americans have prediabetes—a reversible condition, which, if treated, can delay or prevent progression to type 2 diabetes. </p> <p> Physicians and providers can help patients reduce their risk of developing type 2 diabetes by referring them to a local National Diabetes Prevention Program (DPP), a structured, year-long lifestyle-change program that has been proven to help patients delay or prevent diabetes. <a href="https://wsma.org/Shared_Content/News/Latest_News/2018/November/three_steps_to_implement_a_diabetes_prevention_strategy_for_patients">Learn more about the program and how you can help identify and refer your patients</a>. </p> <p> We would also like to hear from you—<a href="https://survey.az1.qualtrics.com/jfe/form/SV_4N5EgKE4HqDT1it">take a brief survey</a> and let us know what other information and resources would be helpful. For more diabetes resources, visit <a href="https://preventdiabetesstat.org/">preventdiabetesstat.org</a>, where you'll find an online tool to calculate net savings and return on investment for starting a diabetes prevention program for your patient population, as well as a comprehensive toolkit with resources on diabetes screening and prevention. </p> </div>11/14/2018 12:00:00 AM1/1/0001 12:00:00 AM
three_steps_to_implement_a_diabetes_prevention_strategy_for_patientsThree steps to implement a diabetes prevention strategy for patientsLatest_NewsShared_Content/News/Latest_News/2018/November/three_steps_to_implement_a_diabetes_prevention_strategy_for_patients<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/graph.png" class="pull-right" /> </div> <h5>November 13, 2018</h5> <h2>Three steps to implement a diabetes prevention strategy for patients </h2> <p>The prevalence of type 2 diabetes has been rising over the past 20 years. Based upon <a href="https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf" target="_blank">statistics</a> on current health trends from the Centers for Disease Control and Prevention, it is estimated that 30 million adult Americans have diabetes, or approximately 10 percent of the adult population.</p> <p>Even more adults are at risk for developing type 2 diabetes; the CDC estimates that currently 84 million adult Americans have prediabetes <sup><a href="#fn1" id="ref1">1</a></sup>, a condition in which glucose levels are higher than normal but not high enough to diagnose type 2 diabetes. Prediabetes can be a reversible condition and treating it can delay or prevent progression to type 2 diabetes. However, the majority of adults who have prediabetes are unaware of their condition. <sup><a href="#fn2" id="ref2">2</a></sup> </p> <p>The National Diabetes Prevention Program (DPP) lifestyle change program is a structured, year-long program that has been proven to help patients delay or prevent type 2 diabetes. Over the past few years, the CDC, the American Medical Association, and health care organizations across the nation have worked together to bring National DPP lifestyle change programs to patients. </p> <p>The following three steps can help you identify patients with prediabetes and refer them to a local program. </p> <h3>Step 1: Identify patients with prediabetes</h3> Prediabetes can be diagnosed through one of three laboratory tests: the hemoglobin A1C, the fasting plasma glucose, or the oral glucose tolerance test. The diagnostic ranges for normal glucose, prediabetes, and type 2 diabetes are in the figure accompanying this article.</div> <div class="col-md-12"> </div> <div class="col-md-12">Risk factors for prediabetes mirror those of type 2 diabetes and include a BMI that is consistent with overweight or obesity, among others. The United States Preventive Services Task Force has a screening recommendation<sup><a href="#fn3" id="ref3">3</a></sup> for abnormal glucose in adults, or you can use an alternative screening protocol. For patients who have had a recent laboratory test, you can use your electronic health record or laboratory reports to identify those who meet the diagnostic criteria for prediabetes. Once patients with prediabetes have been identified, patients should be informed of their diagnosis, either during their next office visit or through an established notification process. This diagnosis should be documented in their chart, you can use the ICD 10 code R73.03 to document prediabetes. <h3>Step 2: Provide patients with evidence-based treatment</h3> <p> The National DPP lifestyle change program is an effective and evidence-based treatment for patients with prediabetes that has been proven to delay or prevent type 2 diabetes <sup><a href="#fn4" id="ref4">4</a></sup>. The program can be delivered in-person, through distance learning, or through virtual modalities. Individuals participate in group sessions led by a trained lifestyle coach that take place on an approximate weekly basis for the first few months of the program and then transition into a maintenance phase, which consists of sessions approximately once a month. The curriculum is comprehensive and gives participants the knowledge and skills to make sustainable healthy lifestyle changes. The curriculum includes topics on healthy diet and physical activity, as well as stress management and behavioral strategies to make lasting changes. The CDC provides oversight and quality assurance of the National DPP lifestyle change program and maintains standards for program sites to receive approval and recognition. You can find program locations near you on the CDC's <a href="https://nccd.cdc.gov/DDT_DPRP/Registry.aspx">National Diabetes Prevention Program website</a>. </p> <h3>Step 3: Monitor and follow-up</h3> <p> If you refer patients to a National DPP lifestyle change program, it is recommended that you monitor their progress and follow-up on their outcomes to help support them. A process should be established with the provider of the National DPP lifestyle change program to share regular updates about participation and achievement of goals for patients in the program. It is recommended that communication occur at designated points during the program. This will also allow you to arrange any appropriate follow-up visits or repeat laboratory testing for patients. </p> <p> By using these three steps, you can help your patients reduce their risk of developing type 2 diabetes and make them aware of the National DPP lifestyle change program. As a result, you empower your patients to improve their health and provide them with the skills and strategies to make long-term healthy lifestyle changes. </p> <p> For more information, consult the <a href="https://preventdiabetesstat.org/toolkit.html">Prevent Diabetes STAT toolkit</a>, which includes patient identification/management protocols, referral templates, and patient awareness and education materials. </p> <p> Your participation in a brief survey regarding this article on prevention strategies for type 2 diabetes would be greatly appreciated. <a href="https://survey.az1.qualtrics.com/jfe/form/SV_cTSthJYUMozHZ7T">Take the survey</a>. </p> <h4>References</h4> <ol> <li>Centers for Disease Control and Prevention, Awareness of prediabetes-United States, 2005-2010, MMWR, Morb Mortal Wkly Rep 2013;62(11) 209-12. <sup id="fn1"><a href="#ref1" title="Jump back to footnote 1 in the text.">↩</a></sup></li> <li>American Diabetes Association. Section 14. Diabetes Advocacy. Standards of Medical Care in Diabetes – 2016, Diabetes Care 2016:39(Suppl 1)S105-S106). <sup id="fn2"><a href="#ref2" title="Jump back to footnote 2 in the text.">↩</a></sup></li> <li>Siu AL Peters JJ, Bibbins-Domingo K, Grossman D, et al. Screening for abnormal blood glucose and type 2 diabetes mellitus: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2015;163:861-8. <sup id="fn3"><a href="#ref3" title="Jump back to footnote 3 in the text.">↩</a></sup></li> <li>Knowler WC, Barrett-Connor E, Fowler SE. et al. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346(6):393-403. <sup id="fn4"><a href="#ref4" title="Jump back to footnote 4 in the text.">↩</a></sup></li> </ol> </div>11/13/2018 12:00:00 AM1/1/0001 12:00:00 AM
wsma_reports_are_we_running_out_of_specialistsWSMA Reports: Are we running out of specialists?Latest_NewsShared_Content/News/Reports/2018/wsma_reports_are_we_running_out_of_specialists<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/WSMA-Reports%20article%20graphic-2018-NovDec.jpg" class="pull-right" /></div> <h5>November 12, 2018</h5> <h2>Are we running out of specialists?</h2> <p> BY MARCIA FRELLICK </p> <p> <em>The following article is our featured cover story in the November/December 2018 issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may <a href="[@]WSMA/News_Publications/Publications/Publications.aspx">purchase a subscription</a>.</em> </p> <p> Patients in parts of Washington seeking care from specialists can face months-long waits for appointments and long drives. The latest estimates show dire shortages in many specialties and some are on track to get much worse in the coming decades. </p> <p> Reports are lacking on the precise deficits, partly because the definition of "specialty" is different among government entities, because people are seeking the care across county and state lines, and because no one entity in the state tracks shortages in all specialties, said Renee Fullerton, workforce programs manager with Washington state's Department of Health. </p> <p> Anecdotally, experts say the biggest shortage is in psychiatry and behavioral health. A physician workforce report in 2016 by the University of Washington Center for Health Workforce Studies showed only 727 psychiatrists delivering direct patient care in the state (10.1 per 100,000 population) and more than half of the state's psychiatrists were 55 or older. And that number dwarfs the number of behavioral/mental health/addiction specialists in Washington. That specialty has only 0.3 per 100,000 population in the state. </p> <p> Ray Hsiao, MD, a child and adolescent psychiatrist practicing in Seattle, said about one-fourth of the counties in Washington don't have a single psychiatrist. </p> <p> Driving the shortage, he said, are two main factors: too few training slots and insurance networks that have narrowed so much that patients can't find a psychiatrist who is taking new patients. </p> <p> "If reimbursement were better, more would be able to take on new patients," he said. </p> <p> Therefore, the most promising solutions currently lie in extending the reach of those already practicing, he said. </p> <p> Dr. Hsiao pointed to the "collaborative care" approach developed by the UW as well as the university's AIMS (Advancing Integrative Mental Health Solutions) Center, which is the role model nationally, he said. The idea is that a mental health team of specialists in a central location helps primary care physicians and providers serve patients with mental health issues in their communities. </p> <p> Traditional telemedicine would open up access, he said, but it needs to work in tandem with people located near the patient to help follow through on care. </p> <p> "With telepsychiatry, you don't really know who you're seeing and you're working with them remotely," Dr. Hsiao pointed out. </p> <h3>Shortages of rheumatologists climbing</h3> <p> Some of the other areas of highest need include rheumatology, neurology, and some surgical subspecialties. Nationally, a 2015 American College of Rheumatology workforce study shows the demand for rheumatologists exceeded supply by 700 full-time physicians in 2015. The shortage is expected to soar to 4,133 by 2030 with increased demand, retirements, and more physicians working part-time. </p> <p> Jeff Peterson, MD, president of the Washington Rheumatology Alliance, said Washington has only about 75 full-time rheumatologists and many regions in the state don't have any. A few big reasons behind the shortage, he said, are the relatively lower pay for rheumatologists because they perform fewer procedures, a lack of training spots for rheumatologists, early retirements, and the pressure to work in hospital systems that are buying up independent practices. </p> <p> "You spend two more years in training and you're going to earn about the same as an internist," he said. </p> <p> But perhaps more important than the pay gap is the pressure to join hospital systems, he said. </p> <p> "We're the cowboys; we think out of the box," Dr. Peterson said. "We're the last stop for most people when they try to figure out the disease process. That spirit needs to be fostered and I think it's being squelched by people who say, 'You need to do it this way.'" </p> <p> Dr. Peterson said the alliance is reaching out to fellows to let them know they have choices. If they do want to practice independently, the alliance can offer support on how to set up smaller businesses. The hope is that will help keep up rheumatologists' satisfaction rates and keep them in the state, he said. </p> <p> Lack of rheumatologists in surrounding states mean patients are turning to Washington for help, contributing to wait times that range from three to six months, he said. </p> <p> It's even worse for pediatric patients, Dr. Peterson said, because those specialists are all at one hospital, Seattle Children's. </p> <p> Geographic disparities nationally are stark as well and numbers show rheumatologists are often centered in urban or suburban areas. The 2015 ACR study showed that 21 percent of adult rheumatologists are in the Northeast and 3.9 percent are in the Southwest. </p> <p> Another area of significant need in Washington is neurology. According to the American Academy of Neurology, Washington had 351.9 neurologists in 2012, 51.3 short of the number needed to meet current demand. By 2025, the shortage is expected to almost double, with a workforce of 411 and a need for 508, leaving a shortage of 97 neurologists. </p> <h3>Looking for answers</h3> <p> Across the state, many are looking to telehealth as a solution. John D. Scott, MD, medical director for University of Washington Telehealth, said telehealth is advancing on three fronts. One is the Project ECHO (Extension for Community Healthcare Outcomes) program, under which primary care physicians all over the Northwest and in rural areas link with a group of specialists at a weekly teleconference and present cases so they can help deliver the care in primary care settings. </p> <p> Another is the electronic consult system for primary care providers who have a question about a patient or are on the fence about whether the patient needs a specialist. The physician can send a message through the electronic health record to a pool of specialists and the appropriate specialist answers on how to proceed. </p> <p> "The beauty of using the EHR is a lot of the relevant data is already in the EHR," Dr. Scott said. "We're now doing that for 14 different specialties and have had more than 4,000 patients who have benefited from this," he said. "A good example is in dermatology; we do about 150 consults a month." </p> <p> The third route is traditional telemedicine with video and high-tech imaging. UW physicians can consult remotely and determine what medications are needed and whether the patient needs to be transported for further care. </p> <p> However, traditional telemedicine has been stuck because of payment barriers that often make performing the service cost-prohibitive for physicians, Dr. Scott said. </p> <p> "The idea is we try not to move people, but to move the knowledge," Dr. Scott said. "We're trying to make the primary care physicians work at the maximum of their training and trying to keep more patients in their communities." </p> <p> A smaller program to add specialists, managed by Fullerton at the DOH, is the J-1 physician visa waiver program. Washington state employers can sponsor international physicians who have done their residencies and fellowships to work in an underserved area of Washington for three years. </p> <p> However, only about 15 specialists are part of the program each year and the program must be a last resort. Employers have to show that have tried and failed to find an American candidate. Typically, the spots have been vacant for quite a long time, Fullerton said. </p> <p> "It's not a first-line option, but it's a way to get access to care," she said. </p> <h3>Legislative wins for specialists</h3> <p> Katie Kolan, JD, director of legislative and regulatory affairs for the WSMA, said the association has successfully fought for changes in the legislature that have provided support for the state's specialists. </p> <p> The WSMA was also able to help fend off the state's attempts to prohibit balance billing—the practice of charging patients for the difference between the dollar amount a provider bills for a service and the amount an insurer is willing to pay. </p> <p> "Balance billing is a big [issue] for anesthesiology, emergency departments, radiology, and pathology," she said. </p> <p> Even more significant was the passage of the Interstate Medical Licensure Compact, signed into law in 2017, which will make it easier for physicians to practice in any state that is a partner to the compact rather than having to go through each state's licensing demands. </p> <p> "It's really important for specialists to be able to practice across multiple states," she said, "especially in the age of telemedicine." </p> <p> <em>Marcia Frellick is a freelance journalist who specializes in health care topics.</em> </p> </div>11/12/2018 12:00:00 AM1/1/0001 12:00:00 AM
Practice_Alerts_November_8__2018Practice Alerts: November 8, 2018Latest_NewsShared_Content/News/Practice_Alerts/Practice_Alerts_November_8__2018<div class="col-md-12"> <div class="col-md-5 pull-right"><img alt="" src="/images/Logos/Practice-Alerts-ArticleImage-Tagline_645x425.jpg" class="pull-right" /></div> <h5> November 8, 2018 </h5> <h2>Practice Alerts</h2> <p>In this issue: Key provisions in Medicare physician fee schedule final rule, changes to Medicare Quality Payment Program for 2019, webinar on new state opioid prescribing rules and much more.</p> <p>For personal assistance, contact the <a href="https://wsma.org/WSMA/Services/Physician_Practice_Helpline/WSMA/Services/Physician_Practice_Helpline/Physician_Practice_Helpline.aspx?hkey=fc908a57-5820-41dc-8a1f-e2a7b1498e3b">WSMA Physician Practice Helpline</a> by emailing Bob Perna, MBA, FACMPE, at <a href="mailto:rjp@wsma.org">rjp@wsma.org</a> or Michelle Lott, CPC, CPMA at <a href="mailto:mml@wsma.org">mml@wsma.org</a>.</p> <p>Jump to section:</p> <!-- NAVIGATION--> <p> <a href="#edu"> Educational Programs</a> </p> <p> <a href="#medicare"> Medicare / Medicare Advantage</a> </p> <p> <a href="#qpp"> Medicare / MACRA Quality Payment Program / MIPS</a> </p> <p> <a href="#commercial"> Commercial Health Insurers</a> </p> <p> <a href="#state"> State Agencies - Medicaid / Healthier Washington</a> </p> <p> <a href="#health"> Health Information Technology / Cybersecurity</a> </p> <p> <a href="#value"> Value-Based Payment</a> </p> <!-- END NAVIGATION--> <a name="edu"></a> <h3> <span style="color: #4bacc6;">EDUCATIONAL PROGRAMS</span> </h3> <h3>New free webinar: Dealing with ERISA claims; WSMA advocacy with U.S. Department of Labor</h3> <p> ERISA, the Employee Retirement Income Security Act of 1974, affects self-insured health plans. Claims payments and denials with ERISA plans are becoming increasingly problematic for physician practices. In years past, only very large companies took on self-insured health care coverage; now, insurers are marketing third-party administrator/"administrative services only" to companies as small as 50–100 employees. As the employers bear full financial risk, these arrangements are not "insurance" products regulated by the state Office of the Insurance Commissioner, meaning the OIC cannot intervene to protect those patients. However, the U.S. Department of Labor does have oversight of ERISA arrangements. </p> <p> The WSMA can assist you in two ways: first, we're collaborating with the Seattle office of the U.S. Department of Labor to offer a new webinar, ERISA and Payment of Healthcare Claims, to be held on Wednesday, Nov. 28, from noon–1 p.m. <a href="https://register.gotowebinar.com/register/4782950741761434882">Register online</a> for this free event. This presentation will provide an overview of ERISA Title I, as well as explain fully insured vs. self-insured health plans, claims procedures and participants' rights, and the role of the Department of Labor. </p> <p> The WSMA can also assist your practice, should you receive a denial or other adverse action on a submitted ERISA claim, through our advocacy on behalf of WSMA members with the U.S. Department of Labor. Please join us for this important presentation. </p> <h3>New free webinar: Understand new state opioid prescribing rules</h3> <p> On Jan. 1, Washington state's <a href="https://wsma.org/Shared_Content/News/Membership_Memo/20180912/medical_commission_finalizes_opioid_prescribing_rules.aspx">new opioid prescribing rules</a> for physicians and physician assistants treating all phases of pain (acute, subacute, and chronic) go into effect. Plan now to attend this new free WSMA webinar on Wednesday, Dec. 19 from noon–1 p.m. designed to help you understand how to comply with the new requirements. <a href="https://register.gotowebinar.com/register/1349059379828828930">Register for this free session online</a>. For questions, contact Jeb Shepard at <a href="mailto:jeb@wsma.org">jeb@wsma.org</a>. This activity has been approved for <em>AMA PRA Category 1 Creditâ„¢</em>. </p> <a name="medicare"></a> <h3> <span style="color: #4bacc6;">MEDICARE / MEDICARE ADVANTAGE</span> </h3> <h3>New Medicare card mailing; Some have received two cards!</h3> <p> The Centers for Medicare & Medicaid Services (CMS) has advised that some Medicare patients have inadvertently received two of the new Medicare cards. In some cases, patients received two cards with the same new alpha-numeric Medicare beneficiary identifier (MBI). However, some patients received two cards with different identification numbers. Any patients who received two cards should be instructed to call 1.800.MEDICARE (1.800.633.4227). </p> <p> If your Medicare patients say they did not get a card, ask them to: </p> <ul> <li>Call 1.800.MEDICARE (1.800.633.4227). There might be something that needs to be corrected, such as updating their mailing address.</li> <li>Sign into MyMedicare.gov to see if CMS mailed their card. If so, they can print an official card. They must create an account if they do not already have one.</li> </ul> <p> Practices can use either the former Social Security number-based health insurance claim number or the new alpha-numeric Medicare beneficiary identifier (MBI) for all Medicare transactions through Dec. 31, 2019. Direct your Medicare patients to <a href="https://www.medicare.gov/NewCard">Medicare.gov/NewCard</a> for information about the mailings and to sign up to get email updates on the status of card mailings. Practice staff should become familiar with using the new online <a href="https://med.noridianmedicare.com/web/jfb/article-detail/-/view/10534/mbi-look-up-tool-available-on-the-noridian-medicare-portal">MBI Look Up Tool</a> which is available on <a href="https://www.noridianmedicareportal.com/">Noridian's secure portal</a>. </p> <h3>New 2019 Opioid Safety Edits for UHC's Medicare Advantage and Prescription Drug Plans</h3> <p> Beginning Jan. 1, UnitedHealthcare's Medicare Advantage and Prescription Drug Plans will be implementing several new point-of-service safety edits to help cut down on the prevalence of opioid misuse and address safety concerns around opioid prescriptions. To better understand these edits and any actions needed, review UHC's <a href="https://www.uhcprovider.com/content/dam/provider/docs/public/resources/pharmacy/MEDADV-Opioid-Readiness-QRG.pdf" target="_blank">2019 Opioid Readiness: Quick Reference Guide for UnitedHealthcare Medicare Advantage and Prescription Drug Plans</a>. </p> <h3>Medicare Advantage: Opioid prescribing in 2019</h3> <p> WSMA staff are researching imminent changes on opioid prescribing in the Medicare Advantage program. Under provisions of the <strong>Comprehensive Addiction and Recovery Act of 2016</strong>, effective Jan. 1, Medicare Advantage plans will be allowed to apply prescribing restrictions on opioids and benzodiazepines. For example, United Healthcare has posted on its website a 2019 Opioid Readiness: Quick Reference Guide, and will include related information in its November provider network bulletin. United Healthcare advises it also has sent a detailed notification letter to its participating providers. </p> <p> WSMA staff are reviewing this matter with CMS Region 10 representatives. CMS' webpage <a href="https://www.cms.gov/Medicare/Prescription-Drug-coverage/PrescriptionDrugCovContra/RxUtilization.html">Improving Drug Utilization Review Controls in Part D</a> provides some further background, yet that webpage currently includes an "Under Construction" reference for 2019 guidance. The WSMA will provide further details as those become available. For questions on Medicare Advantage, contact Bob Perna at <a href="mailto:rjp@wsma.org">rjp@wsma.org</a>. For questions on Washington state prescribing rules, contact Jeb Shepard at <a href="mailto:jeb@wsma.org">jeb@wsma.org</a>. </p> <h3>CMS releases final rule on Medicare's physician fee schedule for 2019</h3> <p> CMS has issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under Medicare's physician fee schedule on or after Jan 1. </p> <p> Key points in the final rule include: </p> <ul> <li>The final 2019 conversion factor, with the budget neutrality adjustment to account for changes in RVUs (all required by law), is $36.04, a slight increase above the 2018 conversion factor of $35.99.</li> <li>The blended reimbursement rate for evaluation and management (E&M) levels of service 99202-99204 and 99212-99215 will be implemented in 2021—so you have two years to ramp up. The Level 5 service is NOT included in this blended rate due to concerns of care for complex patients being impacted.</li> <li>The payment reduction on second procedure using the 25 modifier did NOT pass.</li> <li>The G codes proposed for podiatric services were NOT formally adapted as part of the final rule.</li> <li>The proposed new G codes for primary care services, specialty services, and extended care (formerly known as prolonged physician services) were accepted as part of the final rule for implementation in 2021.</li> <li>Additionally, we are clarifying that for E/M office/outpatient visits for new and established patients, practitioners need not re-enter in the medical record information on the patient's chief complaint and history that has already been entered by ancillary staff or the beneficiary. The practitioner may simply indicate in the medical record that he or she reviewed and verified this information; and</li> <li>Removal of potentially duplicative requirements for notations in medical records that may have previously been included in the medical records by residents or other members of the medical team for E/M visits furnished by teaching physicians. </li> <li>CMS has finalized a policy that, effective Jan. 1, wholesale acquisition cost (WAC)-based payments for Part B drugs determined under section 1847A of the Social Security Act, during the first quarter of sales when the average sale price (ASP) is unavailable, will be subject to a 3 percent add-on in place of the 6 percent add-on that is currently being used. We would also like to reiterate that these changes only apply to WAC-based payment for new Part B drugs.</li> </ul> <p> For questions, contact Michelle Lott (<a href="mailto:mml@wsma.org">mml@wsma.org</a>) at the WSMA Practice Resource Center. </p> <h3>Premera to acquire Soundpath Health Medicare Advantage plan contract</h3> <p> Premera Blue Cross announced that it has received CMS' approval to acquire Catholic Health Initiative's Soundpath Health Medicare Advantage contract, effective Jan. 1. Soundpath Health currently serves over 22,000 customers in Washington state. </p> <p> In its posted <a href="https://www.premera.com/wa/provider/medicare-advantage/premera-acquire-soundpath-health/">press release</a>, Premera noted that Soundpath Health customers will continue to receive their current benefits through the end of the year and that all seniors who receive benefits through Soundpath Health will be properly notified and aware of their plan choices for 2019. </p> <p> Important: In the posted Q&A, Premera states: "You'll need to be contracted and credentialed with Premera in order to see your Soundpath Health patients. To begin the credentialing process, visit <a href="https://www.premera.com/wa/provider/reference/join-our-network/">Join Our Network</a>. You'll need to allow 60 days for the credentialing process. Premera will notify members about in-network providers beginning October 2018." </p> <p> "You can continue to see your Soundpath Health patients through December 31, 2018. Otherwise, you'll need to be contracted and credentialed through Premera to see your Soundpath Health patients who are enrolled in one of Premera's Medicare Advantage plans in 2019." </p> <p> Physicians and practices that have patients covered through Soundpath Health should determine if they are currently contracted and credentialed with Premera. If they are not, Premera likely will not honor claims for services provided as of Jan. 1 and beyond. This presumes that the patient does not change to a different Medicare Advantage plan during the open enrollment period. For questions, contact Bob Perna at <a href="mailto:rjp@wsma.org">rjp@wsma.org</a>. </p> <a name="qpp"></a> <h3> <span style="color: #4bacc6;">MEDICARE / MACRA QUALITY PAYMENT PROGRAM / MIPS</span> </h3> <h3>CMS releases final rule for the 2019 Quality Payment Program </h3> <p> As part of Medicare's physician fee schedule final rule, CMS has issued its policies for year three (2019) of the Quality Payment Program. </p> <p> Key updates to the Merit-based Incentive Payment System (MIPS) for 2019 include: </p> <ul> <li>Expanding the definition of a Merit-based Incentive Payment System (MIPS)-eligible clinician to include new clinician types, including physical therapists, occupational therapists, speech-language pathologists, audiologists, clinical psychologists, and registered dietitians or nutrition professionals.</li> <li>Adding a third element ("Number of Covered Professional Services") to the low-volume threshold determination and providing an opt-in policy that offers eligible clinicians who meet or exceed one or two, but not all, elements of the low-volume threshold the ability to participate in MIPS.</li> <li>Applying facility-based scoring automatically for eligible facility-based clinicians without data submission requirements for individual clinicians and using group data submissions in the MIPS Promoting Interoperability or Improvement Activities categories to identify groups for facility-based scoring determinations.</li> <li>Modifying the MIPS Promoting Interoperability (formerly Advancing Care Information) performance category to support greater electronic health record interoperability and patient access while aligning with the recent changes to the Promoting Interoperability program requirements for hospitals.</li> <li>Moving clinicians to a smaller set of objectives and measures with scoring based on performance for the Promoting Interoperability performance category.</li> <li>Allowing small practices to submit quality data for covered professional services through the Medicare Part B claims submission type for the Quality performance category.</li> </ul> <p> Key updates to Alternative Payment Models (APMs) for 2019 include: </p> <ul> <li>Streamlining the definition of a MIPS-comparable measure in both the Advanced Alternative Payment Models (APMs) criteria and Other Payer Advanced APM criteria to reduce confusion and burden amongst payers and eligible clinicians submitting payment arrangement information to CMS.</li> <li>Updating the MIPS APM measure sets that apply for purposes of the APM scoring standard.</li> <li>Updating the Advanced APM and Other Payer Advanced APM Certified EHR Technology (CEHRT) threshold so that these must require that at least 75 percent of eligible clinicians use CEHRT. For Other Payer Advanced APMs, as of Jan. 1, 2020, the number of eligible clinicians participating in the other payer arrangement who are using CEHRT must also be 75 percent.</li> <li>Extending the 8 percent revenue-based nominal amount standard for Advanced APMs and Other Payer Advanced APMs through performance year 2024.</li> <li>Finalizing proposals to implement the Medicare Advantage Qualifying Payment Arrangement Incentive Demonstration in 2018 under the authority in section 402(b) of the Social Security Amendments of 1967 (as amended).</li> </ul> <h3>Quality Payment Program: Advanced APMs online training course</h3> <p> An updated web-based training course, Quality Payment Program in 2018: Advanced, is now available through CMS' <a href="https://learner.mlnlms.com/Default.aspx">Medicare Learning Network – Learning Management System website</a>. The program covers Advanced Alternative Payment Models (APMs), including how to identify an Advanced APM and a CMS Advanced APM, as well as how to participate in the QPP via an Advanced APM. </p> <p> CMS designates this enduring material for a maximum of 0.5 <em>AMA PRA Category 1 Creditsâ„¢</em>. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Credit for this course expires October 23, 2021. <em>AMA PRA Category 1 Credit â„¢ is a trademark of the American Medical Association</em>. </p> <a name="commercial"></a> <h3> <span style="color: #4bacc6;">COMMERCIAL HEALTH INSURERS</span> </h3> <h3>UHC peer comparison reports now available</h3> <p> Peer comparison reports, previously known as performance reports, offer an analysis of how a physician's risk-adjusted claims data compares with that of others in the same specialty for certain key measures over a period of time. A report will be provided to UnitedHealthcare network physicians when their paid claims show trends that are statistically different from expected practice patterns. </p> <p> Physicians will receive a letter early this month that gives instructions on how to access their peer comparison reports online through Document Vault on Link. Physicians can access Document Vault by signing in to Link through <a href="https://www.uhcprovider.com/">UHCprovider.com</a>. </p> <h3>UnitedHealth Premium® Program: Final date to submit reconsideration request is Nov. 20</h3> <p> On July 27, UnitedHealth Premium program notification letters with instructions for accessing new evaluation details and designations were sent to physicians. The letters included registration instructions for a new Premium program website, <a href="https://unitedhealthpremium.uhc.com/">UnitedHealthPremium.UHC.com</a>. The program gives physicians time to review results and request reconsideration, if necessary. The program provides a minimum of 60 days to request a change to information that may have an impact on a Premium program designation result. The last date to submit a request for reconsideration is Nov. 20. For more information, contact the UHC Health Care Measurement Resource Center at 866.270.5588. </p> <h3>New UnitedHealthcare Policy on discarded drugs and biologicals</h3> <p> UnitedHealthcare will be implementing "Discarded Drugs and Biologicals Policy, Professional and Facility," effective March 1. Policy provisions include: </p> <ul> <li>Payment may be made for the amount of drug or biological administered as well as the amount discarded up to the amount of the drug or biological as indicated on the single use vial or package.</li> <li>The HCPCS code representing the amount administered should be submitted on one line and on a separate line the HCPCS code with JW appended to represent the amount discarded should be submitted.</li> <li>The JW modifier is not permitted when the actual dose of the drug or biological administered is less than the billing unit.</li> <li>The units billed must correspond with the smallest dose (vial) available for purchase from the manufacturer(s) that could provide the appropriate dose for the patient, while minimizing any wastage.</li> <li>Modifier JW is not permitted to identify discarded amounts from a multidose vial (MDV).</li> <li>The amount of the drug administered as well as the discarded drug or biological must be documented in the patient's medical record.</li> </ul> <h3>UnitedHealthcare: Physician and provider education sessions</h3> <p> UHC is convening education events starting Nov. 8. <a href="http://uhs.cvent.com/events/provider-town-hall-meeting/event-summary-3cf102b2845643bb82a3823b8228341d.aspx">Register online</a>. Pre-registration is required as space is limited. Each session runs about two hours. Check-in is 30 minutes before the meeting start time. The sessions will offer updates on UHC policies and products, including commercial, Medicare Advantage, and Community Plan (Medicaid). </p> <p> The events will be held in Spokane on Nov. 8, 1:30-3:30 p.m.; Seattle on Nov. 14, 9:30-11:30 a.m. and 1–3 p.m.; Lynnwood on Nov. 15, 9:30-11:30 a.m.; Astoria on Dec. 3, 1:30-3:30 p.m.; and Lacey/Olympia on Dec. 4, 9-11 a.m. </p> <a name="state"></a> <h3> <span style="color: #4bacc6;">STATE AGENCIES – MEDICAID / HEALTHIER WASHINGTON</span> </h3> <h3>Healthier Washington: WSMA Guide for Physician Practices</h3> <p> Our state's <a href="http://www.hca.wa.gov/about-hca/healthier-washington">Healthier Washington</a> initiatives comprise a "demonstration project" – not a grant – funded by the federal Centers for Medicare and Medicaid Services, intended to transform care delivery, starting with the Medicaid program. </p> <p> The project runs from 2017-2021. The Health Care Authority will receive funding from CMS, contingent upon achieving specific targets, framed around <a href="https://www.hca.wa.gov/about-hca/healthier-washington/medicaid-transformation-resources">three core strategies</a>: </p> <ul> <li>Improving how health care services are paid (value based payment),</li> <li>Ensuring that health care focuses on the whole person (care integration),</li> <li>Build healthier communities through a collaborative approach (through nine regional Accountable Communities of Health - ACHs).</li> </ul> <p> Each of the nine ACHs have selected "projects" to address the transformation of care, including two required projects: Integration of Physical and Behavioral Health, and Addressing the Opioid Use Public Health Crisis. </p> <p> Physicians and their practices can consider participating in this dramatic redesign of care delivery to Medicaid patients and the incremental introduction of value-based payment methodologies, replacing traditional fee-for-service payments. However, these models of care and payment can be complex and confusing. </p> <p> To assist you in this process, we have prepared the <strong>Healthier Washington: WSMA Guide for Physician Practices</strong>. The Guide describes in detail the three Initiatives, along with the various projects being undertaken regionally by the nine ACHs. The Guide also explains the value-based payment models that can be used to reimburse physicians and practices for their participation in the selected projects. These payments are separate and distinct from payments made by managed care organizations for the traditional Medicaid services. </p> <p> Visit our new Healthier Washington page under our Health Insurers section to download a copy of the guide. If you have any questions about the guidance, contact Bob Perna (<a href="mailto:rjp@wsma.org">rjp@wsma.org</a>) or Michelle Lott (<a href="mailto:mml@wsma.org">mml@wsma.org</a>) at the WSMA Practice Resource Center. </p> <a name="health"></a> <h3> <span style="color: #4bacc6;">HEALTH INFORMATION TECHNOLOGY / CYBERSECURITY</span> </h3> <h3>State's Clinical Data Repository web portal is now open for viewing data</h3> <p> Since early July, the CDR web portal has been open for viewing by all licensed processionals, including physical and behavioral health providers and their delegates. If your organization would like to begin using this service, <a href="http://www.formstack.com/forms/?1688456-sjNVJY8V7I">contact OneHealthPort</a>. Some key points: </p> <ul> <li>All organizations that view CDR data must be HIPAA-covered entities and must have a signed HIE participation agreement with OneHealthPort.</li> <li>Only staff with a need to view individual client level data (as determined by their manager and configured by their internal IT access staff) are allowed in the CDR. This is similar to how your organization grants EHR access.</li> <li>Physicians and other providers may view CDR data regardless of whether they are currently submitting continuity of care documents (CCDs).</li> <li>Organizations with less than four providers are exempt from submitting CCDs until July 1, 2019.</li> <li>Organizations using the CDR will not incur training costs from OneHealthPort or HCA, and users can complete training in one hour or less. Reference materials are available on OneHealthPort's website.</li> </ul> <p> OneHealthPort has been conducting clinical usability sessions with providers to refine use cases and gather additional feedback. Several providers, using different EHR systems, have CCD submission success rates in the 90 percent range. Currently, the CDR contains the following information: </p> <ul> <li>Eligibility data for 2.2 million Medicaid managed care lives.</li> <li>Over two years of clinically relevant claims (medical, dental, and pharmacy) for virtually all these lives.</li> <li>Just under 6 million clinical records (CCDs) overall.</li> </ul> <p> The User Acceptance Testing domain is open and ready for testing for those that have not completed CDR onboarding. OneHealthPort continues working with vendors to assist remaining providers to complete their onboarding activities. </p> <p> The state Health Care Authority also has been reaching out to providers that are still in the onboarding process to better understand their challenges and to share some lessons learned. OHP appreciates your patience as the system was being readied for the portal opening and welcomes providers' feedback to improve the CDR. </p> <a name="value"></a> <h3> <span style="color: #4bacc6;">VALUE-BASED PAYMENT</span> </h3> <h3>Value-based payment models: updated AMA/RAND study</h3> <p> Concerns over the feasibility of physician practices' adopting value-based payment models prompted the AMA to commission the RAND Corporation to update its 2014 study on payment models. The <a href="https://www.rand.org/pubs/research_reports/RR2667.html">new study</a>, released in October 2018, presented these findings: </p> <ul> <li>Payment models are changing at an accelerating pace, making it difficult to adapt and keep pace.</li> <li>While payment models are increasingly complex, practices that invested in understanding complex alternative payment models (APMs) found opportunities to earn financial rewards for their preexisting quality, without materially changing patient care. </li> <li>Risk aversion is more prominent among physician practices, avoiding downside risk or off-loading downside risk to partner organizations when possible. </li> </ul> <h3>Succeeding in value-based payment</h3> <p> The WSMA can help our members and their practice staff succeed with value-based payment models through our three tiers of guidance and services. </p> <h4>Tier 1: Reference materials</h4> <p> For foundational knowledge on value-based payment, review AMA's online module <a href="https://www.stepsforward.org/modules/value-based-care">Preparing Your Practice for Value-Based Care</a>. </p> <h4>Tier 2: Educational programs</h4> <p> </p> <p> <a href="https://wsma.org/WSMA/Resources/Practice_Management/OnDemand/Webinars_OnDemand.aspx#vbptakeaction">Value-Based Payment, MACRA/MIPS, Healthier Washington – Take Action Now!</a></p> <p> Both Medicare's MACRA Quality Payment Program and the state's Healthier Washington initiatives are built around value-based payment models. This free 45-minute OnDemand webinar, presented by the WSMA and Attune Healthcare Partners, provides an overview of the value-based payment models currently in play and focuses on specific actions to consider. </p> <h4>Tier 3: Practice-specific engagements</h4> <p> The WSMA and Attune Healthcare Partners have partnered to offer practice-specific consulting engagements to our members on value-based transformation strategies. </p> <p> For more information on the new service, review our free OnDemand webinar <a href="https://wsma.org/WSMA/Resources/Practice_Management/OnDemand/Webinars_OnDemand.aspx#path">Mapping Your Path to Value-Based Care</a>. The webinar addresses: The Problem with Payment Change; The Solution: A Customized Map to Value based care; How the Process Works, Advantages & Results. </p> <p> For more information on WSMA's value-based payment guidance, contact Michelle Lott at <a href="mailto:mml@wsma.org">mml@wsma.org</a>. </p> </div>11/8/2018 12:00:00 AM1/1/0001 12:00:00 AM
historic_midterm_election_sees_dr_schrier_sent_to_congressHistoric midterm election sees Dr. Schrier sent to CongressLatest_NewsShared_Content/News/Latest_News/2018/November/historic_midterm_election_sees_dr_schrier_sent_to_congress<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/People%20non%20stock/Schrier_LS_2018_caption2_645px.jpg" class="pull-right" /> </div> <h5>November 7, 2018</h5> <h2>Historic midterm election sees Dr. Schrier sent to Congress</h2> <p> After months of unprecedented campaign spending, voter enthusiasm, and political divide, the votes were finally tallied on Tuesday (or most of them, anyway). The result? Progressive gains but not the full-on "blue wave" that was seemingly portended in the August primary election, as Republicans stemmed the tide in the state Legislature and added seats in the U.S. Senate. </p> <p> At the congressional level, Democrats will take control of the House of Representatives, highlighted locally by the likely election of WSMA member Dr. Kim Schrier—one of 100 new women in the House. A pediatrician from Issaquah, Schrier is comfortably leading Republican Dino Rossi and looks to be the only female physician in Congress. Not surprisingly, Schrier ran on a platform that featured health care policy prominently. </p> <p> Schrier will join a new Democratic majority that will surely provide a foil to a Republican-retained Senate and the Trump administration—and likely usher in even more political divide in D.C. Two other closely-watched Washington races saw incumbent Republicans re-elected to Congress, with the victories of Rep. Cathy McMorris Rodgers and Rep. Jaime Herrera Beutler. </p> <p> Statewide ballot measures yielded a victory for a gun control initiative that largely aligns with WSMA policy on requiring safe storage and restricting the purchase of firearms under certain circumstances. But a proposal to establish a new state carbon tax to combat climate change, endorsed by the WSMA at October's House of Delegates, was defeated. Elsewhere, three states approved ballot measures to expand Medicaid (Idaho, Nebraska, and Utah). </p> <p> The state Legislature looks likely to add several Democrats to the House of Representatives and Senate, widening Democratic control of both chambers. While a less drastic swing than some had predicted, the gains are significant and will have implications for health care policy and the state budget over the next two years. </p> <p> In the state Senate, Democrats lead in two seats that are currently held by Republicans, the 30th District centered on Federal Way and the Kitsap Peninsula's 26th District, with several other races too close to call. And Democrats are leading in seven state House seats that Republicans hold, though again, final tallies will depend on late returns that have favored Republicans in recent years. If those results hold, however, Democratic margins of control would shift to 27-22 in the Senate and 57-41 in the House. </p> <p> Voter turnout in Washington state is on the highest pace for a midterm election in generations. That type of turnout would typically benefit Democrats (as Republicans are more reliable voters in midterms), though the effect was muted by high enthusiasm by folks on both sides of the aisle. Whether the enthusiasm is attributable to Trump, the campaign spending that resulted in a deluge of ads and mailers, or just general increased interest in politics remains to be seen. </p> <p> What we do know is that the next election cycle started even before this update will be published, with the 2020 presidential race gearing up and folks jockeying for position at the state level. WSMA's advocacy will transition to the legislative session that begins in January, but WAMPAC—the WSMA's nonpartisan campaign arm—is always monitoring the state's election landscape and looking for opportunities to engage physicians. If you're interested in getting more involved, consider joining the <a href="https://wsma.org/WSMA/Advocacy/WAMPAC/WSMA/Advocacy/WAMPAC/WAMPAC.aspx?hkey=269c3c03-cf72-4568-be5b-7893557300a7">WAMPAC Diamond Club</a> to help ensure the physician voice remains relevant as campaigns continue to get more expensive, and more important, than ever. </p> </div>11/7/2018 12:00:00 AM1/1/0001 12:00:00 AM
weekly_rounds_2018_11_5_collective_effort_drives_effective_changeWeekly Rounds: November 5, 2018 - Collective effort drives effective changeLatest_NewsShared_Content/News/Weekly_Rounds/2018/weekly_rounds_2018_11_5_collective_effort_drives_effective_change<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="Weekly Rounds logo" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /></div> <h5>November 5, 2018</h5> <h2>Collective effort drives effective change</h2> <p> Jennifer Hanscom, Executive Director/CEO </p> <p> Late last week, the power of our collective voice and the clout of organized medicine became tangibly evident. As noted in the <a href="https://wsma.org/Shared_Content/News/Weekly_Rounds/2018/weekly_rounds_2018_09_03_five_things_you_need_to_know_this_week">Sept. 3 edition of Weekly Rounds</a>, the WSMA and 170 other physician and health care organizations united to vehemently oppose a proposal to collapse Medicare payment rates for office and outpatient visit services. And then, thanks to the house of medicine speaking out in full force, the Centers for Medicare and Medicaid Services delayed implementation of the proposed changes for two years. </p> <p> In the past few days, the American Medical Association—which led the effort to oppose the payment changes—reported that CMS "acknowledged the work of the AMA's CPT/RUC Workgroup on E/M and has <strong>postponed any coding and payment-related changes for E/M office visit services until CY2021</strong>." </p> <p> This delay in implementation allows the CPT Editorial Panel to "consider the Workgroup's proposal in February of 2019 prior to prompt consideration by the AMA/Specialty Society RVS Update Committee (RUC)." </p> <p> In further good news, CMS did finalize several changes to E/M documentation guidelines, which were strongly supported by organized medicine. These changes will take effect January 1: </p> <ul> <li>Eliminating the requirement to document medical necessity of furnishing visits in the home rather than the office. </li> <li>Physicians will no longer be required to re-record elements of history and physical exam when there is evidence that the information has been reviewed and updated. </li> <li>Physicians must only document that they reviewed and verified information regarding chief complaint and history that is already recorded by ancillary staff or the patient.</li> </ul> <p> Other Coding/Payment Proposals Related to E/M </p> <ul> <li>The following policies were also opposed by the AMA and will not be implemented by CMS:</li> <li>Payment reductions by 50 percent for office visits that occur on the same date as procedures (or a physician in the same group practice). </li> <li>CMS proposed to no longer allow for podiatry to report CPT codes 99201-99215 and instead would use two proposed G-codes for podiatry office visits. CMS also proposed a new prolonged service code that would have been implemented to add-on to any office visit lasting more than 30 minutes beyond the office visit (i.e. hour-long visits in total).</li> <li>Condensed practice expense payment for the E/M office visits, by creating a new indirect practice expense category solely for office visits, overriding the current methodology for these services by treating Office E/M as a separate Medicare Designated Specialty. This change would also have resulted in the exclusion of the indirect practice costs for office visits when deriving every other specialty's indirect practice expense amount for all other services that they perform, which would have resulted in large changes in payment for many specialties (e.g., a greater than 10 percent payment reduction for chemotherapy services). </li> </ul> <p> For CY 2021, CMS conveyed its intention to propose two basic payment rates for office visit services, one for straightforward visits and another for complex visits. In addition, CMS noted its intent to propose add-on codes for primary care and inherently complex specialty E/M visits. </p> <p> CMS noted they will also consider input from the AMA and the CPT/RUC Workgroup on E/M as well as input from across the medical community. </p> <p> We're grateful to the AMA for its quick analysis of the E/M sections of the final rule, and for leading the nationwide coordinated effort to oppose the problematic proposals offered by CMS. </p> <p> If you are in the position of deciding whether to renew/join the AMA, consider this as just one example of how organized medicine works on your behalf. Changes like these don't happen because of one individual's comment or one medical group's response. This type of high-level change requires the power of 170 organizations together in a critical mass that demands attention and forces policy makers to take notice and act. </p> <p> I hope this prompts <strong>you</strong> to act. Your membership in the AMA and the WSMA really does matter. There is no doubt that together we are stronger. </p> </div>11/5/2018 12:00:00 AM1/1/0001 12:00:00 AM
the_wsma_formally_opposes_dhs_rule_that_increases_adverse_events_for_childrenThe WSMA formally opposes DHS rule that increases adverse events for childrenLatest_NewsShared_Content/News/Latest_News/2018/November/the_wsma_formally_opposes_dhs_rule_that_increases_adverse_events_for_children<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/trym-nilsen-662466-unsplash.jpg" class="pull-right" /> </div> <h5>November 2, 2018</h5> <h2>The WSMA formally opposes DHS rule that increases adverse events for children</h2> <p>Seattle, Wash. - The Washington State Medical Association (WSMA) today sent a <a href="javascript://[Uploaded files/News and Publications/Press Room/WSMA formal comment on FSA-FINAL-110218.pdf]">formal public submission</a> into the Federal Register strongly opposing the proposed rule "<a href="https://www.federalregister.gov/d/2018-19052">Apprehension, Processing, Care, and Custody of Alien Minors and Unaccompanied Alien Children</a>" (Document Citation 83 FR 45486, Agency/Docket Number: ICEB-2018-0002). The final day to submit comments on this proposed rule is November 6, 2018. </p> <p>The U.S. Department of Homeland Security (DHS) and the Department of Health and Human Services (HHS) propose to “amend regulations relating to the apprehension, processing, care, custody, and release of alien juveniles.” In 1985, plaintiffs in a class action lawsuit, Flores v. Reno, challenged the policies of the legacy Immigration and Naturalization Service (INS) relating to the detention, processing, and release of child immigrants. The parties reached a settlement agreement, referred to as the Flores Settlement Agreement (FSA).</p> <p>The Flores Settlement Agreement, in addition to placing other restrictions on the government’s actions, requires that children be released from custody within 20 days, (preferably to a parent) and establishes a general policy that a detained child be held in the least restrictive setting, taking into account the child’s age and special needs, until the child can safely be released (generally, in a non-secure facility licensed by a child welfare entity). </p> <p>The administration's proposed regulation would end key provisions of the FSA. The WSMA submitted formal comment to the Department of Homeland Security opposing the proposed rule, opposing policy that is likely to increase Adverse Childhood Events (ACEs) and called on the administration to retain the Flores Settlement Agreement. </p> <p>“The WSMA and our House of Delegates voted at our Annual Meeting in October to endorse a resolution that opposes family immigration detention and the separation of children from their parents in detention. The detention of children is harmful and medical research shows it can result in lifelong health and mental health consequences,” said Donna Smith, MD, past president of WSMA and Seattle area pediatrician.</p> <p>From a healthcare perspective, children held in detention facilities experience increased Adverse Childhood Events (ACEs). ACEs refer to categories of abuse, neglect and household/family challenges that children experience during the first 18 years of life. Peer-reviewed research demonstrates that ACEs have negative health outcomes, and the more adverse events a child experiences, the more that child is likely to experience an increased severity of poor health outcomes.</p> <p>Current immigration practices that force the separation of families result in children experiencing at least three ACEs—parental separation, emotional neglect and physical neglect from parents who are forcibly separated from their children and cannot provide care for them.</p> <p>Experiencing an increased number of ACEs in childhood specifically has been shown to increase the risk for autoimmune disease, alcoholism, chronic obstructive pulmonary disease, depression, early death, illicit drug use, ischemic heart disease, liver disease, poor work performance, intimate partner violence, sexually transmitted diseases, smoking, suicide attempts, and unintended pregnancies into adulthood.</p> <p>Studies of detained immigrant children have further shown that children often subsequently suffer negative physical and emotional symptoms from detention, including anxiety, depression and post-traumatic stress disorder.</p> <p>The Washington State Medical Association opposes policies that force family immigration detention and the separation of children from their parents and it supports policies that promote unification of families at the border.<br /> <br /> <em>Photo courtesy of <a href="https://unsplash.com/@trymon?utm_medium=referral&utm_campaign=photographer-credit&utm_content=creditBadge">Trym Nilsen on Unsplash</a>.</em><br /> <br /> </p> </div>11/2/2018 12:00:00 AM1/1/0001 12:00:00 AM
weekly_rounds_2018_10_29_working_together_for_the_good_of_health_careWeekly Rounds: October 29, 2018 - Working together for the good of health careLatest_NewsShared_Content/News/Weekly_Rounds/2018/weekly_rounds_2018_10_29_working_together_for_the_good_of_health_care<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" class="pull-right" src="/images/Logos/Weekly_Rounds_Article_Image_645x425.jpg" /></div> <h5>October 29, 2018</h5> <h2>Working together for the good of health care</h2> <p> Jennifer Hanscom, Executive Director/CEO </p> <p> Just over a week ago, hundreds of WSMA members convened at the Historic Davenport Hotel in Spokane for the annual meeting of our House of Delegates. It's always energizing to connect face-to-face with our members and to hear from them about issues of concern. </p> <p> The conversations I had at our meeting echoed other discussions I've had lately, including at a recent dinner with physicians from all over the country. Our broad-ranging dialog covered familiar ground: How do we engage today's physicians in our organizations, and how do we engage our members in the larger health care conversation? </p> <p> A full-blown crisis is often a catalyst to motivate like-minded folks to act. There's nothing like an immediate or impending threat to get people organized, engaged, and mobilized. Even recent history bears this out, if you think about public health concerns like lead in the water in Michigan; or longer ago, smallpox and flu epidemics, HIV/AIDS, polio, etc. </p> <p> A recent New York Times article, "<a href="https://www.nytimes.com/2018/10/06/opinion/sunday/climate-change-global-warming.html">Stopping Climate Change Is Hopeless. Let's Do It</a>," opined that "if the human species specializes in one thing, it's taking on the impossible." In that article, Auden Schendler and Andrew P. Jones wrote that: "…we must realize that real progress comes from voting, running for office, marching in protest, writing letters, and uncomfortable but respectful conversations with fathers-in-law. This work must be habitual. Every day some learning and conversation. Every week a call to Congress. Every year a donation to a nonprofit advancing the cause. In other words, a practice." </p> <p> That admonition applies to any situation where we must work to advance change, whether for the good of society, or in WSMA's case, the good of patients and the profession. Real change in health care comes about slowly, takes practice, and takes engagement. And it shouldn't take a crisis to motivate us to action. It should be an everyday ritual. </p> <p> Advancing change is exactly where "slow and steady wins the race" is the approach that works. The WSMA provides the structure for that approach to succeed. Day in and day out, our sole purpose is to advance an agenda that benefits the profession and the patients you treat. But to advance a meaningful agenda—one that will have a true impact on health care and medicine—we need your direction, feedback, expertise, and engagement. And we need your voice not just once, and not just on an issue that pertains solely to your specialty or practice setting. We need all physicians working together all the time to advance what's best for medicine. </p> <p> Members drive our work. It is our members who advise us on practical and workable solutions to balance billing and opioid prescribing. Our members charge us to take a leading role to address gun violence and suicide, clean air, and social determinants of health. Members inform us on what hinders quality patient care and depletes the joy of practice. And it's our members who are willing to stand up and challenge unnecessary care and waste in the system. </p> <p> That input drives our agenda, and from there it is WSMA's job to bring your voice to the forefront of debate on these issues. </p> <p> In the coming months, lawmakers will be making critical decisions that could have enormous implications to physicians and patients. </p> <p> Just as teamwork is a key part of health care, teamwork is also key to our efforts representing you. In effect, we are your dyad partner, working to represent your interests while soliciting your feedback and direction. </p> <p> The WSMA's superpower is its ability to bring specialties together, bridge generational divides, unite diverse perspectives, and democratically balance it all to find solutions to challenges faced by the profession, patients, and communities. We saw this in action at the House of Delegates in mid-October—see this work for yourself by <a href="https://wsma.org/WSMA/About_Us/Leadership/House_of_Delegates/WSMA/About/Leadership/House_of_Delegates/House_of_Delegates.aspx?hkey=e2c50002-384d-4ff7-9116-5ce7a51116e7">reviewing the policies adopted by delegates the 2018 WSMA Annual Meeting</a>. </p> <p> Your voice matters to us and to the profession. This is our strength that ensures a positive working and care environment and leads us to our vision of making Washington the best place to practice medicine and to receive care. </p> <p> Thanks for standing with us in this work. It really does matter. </p> </div>10/29/2018 12:00:00 AM1/1/0001 12:00:00 AM
gun_violence_clean_air_public_option_and_more_new_policy_adopted_at_wsma_annual_meetingGun violence, clean air, public option and more: New policy adopted at WSMA Annual MeetingLatest_NewsShared_Content/News/Membership_Memo/20181024/gun_violence_clean_air_public_option_and_more_new_policy_adopted_at_wsma_annual_meeting<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/2018-WSMAAnnual-HOD-article_645x425.jpg" class="pull-right" /> </div> <h5> October 24, 2018 </h5> <h2>Gun violence, clean air, public option and more: New policy adopted at WSMA Annual Meeting</h2> <p>Each year, the <a href="[@]WSMA/About/Leadership/House_of_Delegates/House_of_Delegates.aspx">WSMA House of Delegates</a> (HOD) meets to establish the mandates and policies of the medical association. At this year's meeting, Oct. 13 and 14 at the Historic Davenport Hotel in Spokane, the 128<sup>th </sup>annual meeting of the HOD since the founding of the association, 30 resolutions were adopted, directing the association's work on behalf of physicians, patients and the house of medicine for the months and years ahead.</p> <p>Echoing the actions of AMA delegates during the AMA meeting earlier this year, WSMA delegates took a strong stance on gun violence, adopting policies directing the WSMA to:</p> <ul> <li>Support policy that raises the minimum age to purchase a firearm to 21 years of age.</li> <li>Support the elimination of laws intruding on physicians' and patients' rights to discuss gun violence.</li> <li>Support legislation that would restrict the sale and private ownership of large-clip, high-rate-of-fire automatic and semi-automatic firearms.</li> <li>Support closing loopholes in gun purchases online and at unregulated gun shows.</li> <li>Support policy that creates weapons-free zones for medical practice settings, allowing exceptions for law enforcement.</li> <li>Encourage members to screen for risk factors of firearm injury and educate patients about prevention and safe storage.</li> <li>Urge the state and federal government to fund research on the causes and prevention of firearm violence and injury and ensure that the databases and systems necessary for research and public health surveillance are available and publicly accessible.</li> </ul> <p>Other public health policies adopted during the meeting direct the WSMA to:</p> <ul> <li>Advocate for measures to identify, treat, and eliminate sources of childhood lead poisoning in Washington state.</li> <li>Publicly oppose the enforcement of immigration policy on undocumented immigrants that impose increased adverse childhood events.</li> <li>Support the elimination of the manufacture, distribution, and sale of combustible cigarettes.</li> <li>Take measures to promote clean energy, including endorsing <a href="https://weiapplets.sos.wa.gov/MyVoteOLVR/OnlineVotersGuide/Measures?language=en&electionId=71&countyCode=xx&ismyVote=False&electionTitle=2018%20General%20Election%20#ososTop">Washington Initiative Measure 1631</a> on the 2018 general election ballot.</li> <li>Initiate a collaborative effort with relevant organizations to encourage hospitals in Washington state to treat opioid use disorder as a chronic disease</li> <li>Support policy that eliminates barriers to, increases funding for, and promotes access to medication-assisted treatment at all state-certified drug treatment facilities.</li> </ul> <p>Resolutions adopted regarding other legislative and professional affairs direct the WSMA to:</p> <ul> <li>Support a public option for Washington state (offering for purchase by all Washington residents the same coverage as that offered to Washington state employees through the Public Employees Benefit Board and the School Employees Benefits Board, with subsidies available to those who cannot afford the premium cost and who do not qualify for Medicaid), but not to the exclusion of other potential models.</li> <li>Support changing the current physician assistant delegation agreement from the current Washington Medical Commission-based model to an employer/practice-based model and support defining the physician assistant scope of practice by the practices of the local supervising physicians.</li> <li>Endorse non-discrimination in physician employment, compensation, and advancement opportunities consistent with the Washington State Equal Pay Opportunity Act.</li> <li>Support physician whistleblower protections in legislation.</li> <li>Promote the sole use of the metric system across the entire health care system.</li> </ul> <p>Visit the <a href="[@]WSMA/About/Leadership/House_of_Delegates/House_of_Delegates.aspx">House of Delegates page</a> for a comprehensive list of policies adopted at the 2018 WSMA Annual Meeting.</p> <p>Plan now to attend the 2019 WSMA Annual Meeting, Oct 12 and 13 at the Hilton Seattle Airport & Conference Center—save the date. To learn more about the Annual Meeting of the WSMA House of Delegates and its role shaping policy for the medical association, visit the <a href="[@]/WSMA/Events/Annual_Meeting/WSMA/Events/Annual_Meeting/Annual_Meeting.aspx">meeting webpage</a>.</p> </div>10/24/2018 12:00:00 AM1/1/0001 12:00:00 AM
spokane_geriatrician_tom_schaaf_md_installed_as_wsma_president_for_2018_19Spokane geriatrician Tom Schaaf, MD, installed as WSMA president for 2018-19Latest_NewsShared_Content/News/Membership_Memo/20181024/spokane_geriatrician_tom_schaaf_md_installed_as_wsma_president_for_2018_19<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/2018-10-WSMADrSchaaf-1-645x425.jpg" class="pull-right" /> </div> <h5> October 24, 2018 </h5> <h2>Spokane geriatrician Tom Schaaf, MD, installed as WSMA president for 2018-19</h2> <p>On Saturday at the 2018 WSMA Annual Meeting in Spokane, the WSMA inaugurated its new president, Spokane geriatrician and hospice care physician <strong>Tom Schaaf, MD, MPH</strong>. Dr. Schaaf serves as the chief medical officer of Providence Home and Community Care in Tukwila and provides patient care at Providence Sound Hospice in Olympia.</p> <p>During his inauguration speech at the annual meeting, Dr. Schaaf shared with delegates why he has pursued leadership roles in medicine, and why physician leadership is critical to the future of the house of medicine. <a href="[@]Shared_Content/News/Weekly_Rounds/2018/weekly_rounds_2018_10_18_if_physicians_do_not_lead_someone_else_will.aspx">Read his full speech</a>.</p> <p>Also elected as officers at the meeting were: <strong>Bill Hirota, MD</strong>, Tacoma gastroenterologist, president-elect; <strong>Nathan Schlicher, MD, JD</strong>, Tacoma emergency physician, 1st vice president; <strong>Mika Sinanan, MD, PhD</strong>, Seattle surgeon, 2nd vice president; <strong>Katina Rue, DO</strong>, Yakima osteopathic physician, secretary-treasurer; <strong>Nariman Heshmati, MD</strong>, Mukilteo OB/GYN, assistant secretary-treasurer. The seventh officer of WSMA's executive committee is past-president <strong>Donna Smith, MD</strong>, Seattle pediatrician, who will serve as committee chair.</p> <p><em>Photo courtesy of Andrea Peer Photography.</em></p> </div>10/24/2018 12:00:00 AM1/1/0001 12:00:00 AM
wsma_honors_teamhealth_northwest_and_peacehealth_medical_group_for_patient_safety_effortsWSMA honors TeamHealth Northwest and PeaceHealth Medical Group for patient safety effortsLatest_NewsShared_Content/News/Membership_Memo/20181024/wsma_honors_teamhealth_northwest_and_peacehealth_medical_group_for_patient_safety_efforts<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/2018-10WSMAFoundation-074_TeamHealth_ptsafetyaward_Schlicher_Smith_645x425.jpg" class="pull-right" /> </div> <h5> October 24, 2018 </h5> <h2>WSMA honors TeamHealth Northwest and PeaceHealth Medical Group for patient safety efforts</h2> <p>Each year at its annual meeting, the WSMA honors innovative patient safety initiatives in the ambulatory care setting. This year, two Washington health care organizations were recognized: TeamHealth Northwest at CHI Franciscan and PeaceHealth Medical Group.</p> <p>The awards were presented during the WSMA Foundation 50th Anniversary Banquet on Saturday evening at the Historic Davenport Hotel in Spokane:</p> <p>The William O. Robertson Patient Safety Award of Excellence was presented to TeamHealth Northwest for its work on addressing opioid prescribing practices in the emergency department. Receiving the award on behalf of TeamHealth was <strong>Nathan Schlicher, MD, JD</strong>, regional director of quality assurance.</p> <p>The William O. Robertson Patient Safety Award of Achievement was presented to PeaceHealth Medical Group for its work elevating and integrating advance care planning within their system. Receiving the award on behalf of PeaceHealth Medical Group were <strong>Hilary Walker</strong>, program coordinator for advance care planning; <strong>Daleasha Hall</strong>, hospice & palliative care system director; and <strong>Robin Virgin, MD </strong>primary care system medical director.</p> <p>For more information on the initiatives, read the <a href="[@]Shared_Content/News/Press_Releases/2018/WSMA_patient_safety_awards_go_to_TeamHealth_Northwest_and_PeaceHealth_Medical_Group.aspx">press release</a>.</p> <p>The WSMA established the William O. Robertson Patient Safety Award in 2005, in honor of the late William O. Robertson, MD, who was a champion for patient safety, risk management and quality improvement throughout his long and distinguished career.</p> <p><em>Pictured: Dr. Nathan Schlicher and Dr. Donna Smith. Photo courtesy of Andrea Peer Photography.</em></p> </div>10/24/2018 12:00:00 AM1/1/0001 12:00:00 AM
wsma_led_initiative_successfully_driving_safe_opioid_prescribingWSMA-led initiative successfully driving safe opioid prescribingLatest_NewsShared_Content/News/Membership_Memo/20181024/wsma_led_initiative_successfully_driving_safe_opioid_prescribing<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/Logos/BPBT_logo_645px.png" class="pull-right" /> </div> <h5> October 24, 2018 </h5> <h2>WSMA-led initiative successfully driving safe opioid prescribing</h2> <p>Better Prescribing, Better Treatment, a WSMA-launched safe prescribing effort for Apple Health (Medicaid) physicians and patients, is showing dramatic results in its first year. The WSMA, along with initiative partners the Washington State Hospital Association and the state Health Care Authority, <a href="@/Shared_Content/News/Press_Releases/2018/Public-private_safe_prescribing_initiative_results_in_reductions_in_Medicaid_opioid_prescriptions" name="reported"></a><a href="[@]Shared_Content/News/Press_Releases/2018/Public-private_safe_prescribing_initiative_results_in_reductions_in_Medicaid_opioid_prescriptions.aspx">reported</a> that, since its introduction, the initiative has reduced opioid prescriptions exceeding new state Apple Health prescribing guidelines by nearly 70 percent. It has also reduced total Apple Health opioid prescriptions for acute (non-chronic) pain by nearly 30 percent.</p> <p>Better Prescribing, Better Treatment uses a peer-to-peer, non-punitive approach to help ensure physicians and other prescribers who see Apple Health patients are not overprescribing opioids while keeping appropriate pain treatments accessible for patients who need them. The initiative takes a three-pronged approach to safe prescribing:</p> <ul> <li><strong>Apple Health prescribing policy</strong>. The initiative encourages compliance with a new opioid prescribing policy for Washington's Apple Health program that establishes pill limits for all opioid prescriptions written for the treatment of acute pain.</li> <li><strong>Prescriber discretion</strong>. The initiative emphasizes a broad exemption in the policy that allows the prescribing clinician to override those limits if they feel it's in the best interest of their patient by simply documenting in the medical record and indicating the reason on the prescription.</li> <li><strong>Physician-led feedback program. </strong>Called Washington Opioid Reports, the feedback program provides data compiled from the state's prescription monitoring program to physicians and other prescribing providers allowing them to see how their opioid prescribing practices compare to others in their health care system and specialty.</li> </ul> <p>For details on the initiative's progress, read the <a href="[@]Shared_Content/News/Press_Releases/2018/Public-private_safe_prescribing_initiative_results_in_reductions_in_Medicaid_opioid_prescriptions.aspx">press release</a>. More than 20 health systems and groups are currently participating in the Better Prescribing, Better Treatment initiative, representing more than 11,000 Apple Health prescribers in the state. If you see Medicaid patients and your organization would like to participate, simply email <a href="mailto:opioidreportsadmin@wsma.org">opioidreportsadmin@wsma.org</a>.</p> <p>The WSMA, along with the initiative partners and the Department of Health, are currently looking at merging all data from the state's prescription monitoring program with Washington Opioid Reports and expanding Better Prescribing, Better Treatment's peer-to-peer approach beyond Medicaid to help improve care for all Washingtonians regardless of insurer.</p> </div>10/24/2018 12:00:00 AM1/1/0001 12:00:00 AM
 

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